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Farhan SY, Abraha D, Edyedu I, Molen SF, Mauricio W, Odong SO, Mugeni M, Muhumuza J. Factors associated with early inhospital adverse outcome following surgery for acute appendicitis in Uganda: a multicenter cohort. Perioper Med (Lond) 2024; 13:51. [PMID: 38831345 PMCID: PMC11149220 DOI: 10.1186/s13741-024-00412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/31/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Surgery for acute appendicitis has been associated with significant morbidity. This study aimed to determine the factors associated with early inhospital adverse outcomes following surgery for acute appendicitis in Uganda. METHODS This was a multicentre, prospective cohort in which early inhospital outcome following surgery for acute appendicitis was assessed at 4 regional referral hospitals in Uganda. The occurrence of complications during the admission period was documented as well as the length of hospital stay. Factors associated with adverse outcomes were determined using Poisson regression. RESULTS Of the 102 patients who underwent surgery for acute appendicitis, the majority were males 79(77.5%) with a mean age of 23.8(SD = 12.5) years. The perforated appendix was seen in 26 (25.5%) patients. Post-operative complications occurred in 21(20.6%) with the commonest being surgical site infection in 19(18.6%) patients. The median length of hospital stay was 3(IQR = 3-4) days with 43(42.2%) staying in hospital for more than 3 days. The presence of anemia (Hb < 8) (aRR = 1.376, CI = 1.159-1.634, P = < 0.001) and having a perforated appendix (aRR = 1.263, CI = 1.026-1.555, P = 0.027) were independently associated with occurrence of complications while being HIV positive (aRR = 1.379, CI = 1.105-1.721, P = 0.005) and having a perforated appendix (aRR = 1.258, CI = 1.019-1.554, P = 0.033) were independently associated with prolonged hospital stay. CONCLUSION Community education about early presentation is still required in order to reduce the number of patients that present late which should, in turn, reduce the risk of complications and length of hospital stay.
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Affiliation(s)
- Sharif Yusuf Farhan
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda.
| | - Demoz Abraha
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Isaac Edyedu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Selamo Fabrice Molen
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - William Mauricio
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Samuel Oledo Odong
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Michael Mugeni
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda.
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Lin YS, Lai CC, Liu YC, Kuo SC, Su SB. Changing Incidence and Characteristics of Photokeratoconjunctivitis During the COVID-19 Pandemic. West J Emerg Med 2024; 25:368-373. [PMID: 38801043 PMCID: PMC11112667 DOI: 10.5811/westjem.17882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Photokeratoconjunctivitis (PKC) is primarily caused by welding. However, inappropriate use of germicidal lamps, which have been widely used following the COVID-19 outbreak, can also cause PKC. Our goal in this study was to investigate the incidence of and changes in the causes of PKC during the coronavirus 2019 (COVID-19) pandemic. Methods We conducted a single-center, retrospective observational study. The health records of patients who visited the emergency department in a tertiary care hospital from January 1, 2018-December 31, 2021 and were diagnosed with PKC, were reviewed. We then conducted an analysis to compare the characteristics of PKC before and after COVID-19 began and the features of PKC caused by welding and germicidal lamps. Results There were 160 PKC cases with a clear etiology before the COVID-19 pandemic and 147 cases during the COVID-19 pandemic. No significant differences in age and gender were detected between the two groups. The incidence of PKC induced by the use of germicidal lamps during the COVID-19 pandemic was significantly higher (10.2%) than the incidence before the pandemic (3.1%). The ratio of females to males in the germicidal lamp subgroup was significantly higher than the ratio in the welding subgroup. Limitations included incomplete information due to the retrospective nature of the study, underestimation of incidence, and possible recall bias. Conclusion In the era of COVID-19, clinicians should be aware of the hazards of germicidal lamps. Although the COVID-19 pandemic seems to show signs of easing, new infectious diseases that require protective measures could still emerge in the future. Therefore, injuries related to germicidal lamps deserve more public health attention.
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Affiliation(s)
- Yu-Shiuan Lin
- Chi Mei Medical Center, Department of Ophthalmology, Tainan, Taiwan
| | - Chih-Cheng Lai
- Chi Mei Medical Center, Division of Hospital Medicine, Department of Internal Medicine, Tainan, Taiwan
| | - Yu-Chang Liu
- Chi Mei Medical Center, Department of Emergency Medicine, Tainan, Taiwan
- National Cheng Kung University, College of Medicine, Department of Environmental and Occupational Health, Tainan, Taiwan
| | - Shu-Chun Kuo
- Chi Mei Medical Center, Department of Ophthalmology, Tainan, Taiwan
- Chung Hwa University of Medical Technology, Department of Optometry, Jen-Teh, Tainan, Taiwan
| | - Shih-Bin Su
- Chi Mei Medical Center, Department of Occupational Medicine, Tainan, Taiwan
- Chi Mei Medical Center, Department of Family Medicine, Tainan, Taiwan
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Bavikatte A, Isswiasi S, Farag K. Unchanged Faces of Acute Appendicitis: Exploring Presentation and Treatment Amidst the COVID-19 Pandemic. Cureus 2024; 16:e60674. [PMID: 38770054 PMCID: PMC11104279 DOI: 10.7759/cureus.60674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The emergence of the COVID-19 pandemic necessitated the implementation of novel guidelines for managing appendicitis, prompting an evaluation of its effects on patient presentation and treatment at a district general hospital. Healthcare facilities worldwide have adapted protocols to meet the unique challenges of the pandemic, ensuring safe and efficient care. Our study assesses the pandemic's influence on patient demographics, clinical outcomes, surgical procedures, and adherence to guidelines among individuals undergoing emergency appendicitis surgery. Through this investigation, we aimed to determine whether significant deviations occurred in managing acute appendicitis amidst the pandemic. Methodology Consecutive adult patients (≥18 years) diagnosed with acute appendicitis were included in two cohorts for this retrospective analysis, comparing cases treated during the COVID-19 pandemic period (April to September 2020) with those treated one year prior. All patients underwent standardized assessments upon emergency department admission, including imaging studies and COVID-19 testing. Demographics, laboratory results, surgical details, and outcomes were compared between the pre- and post-pandemic groups, focusing on their overall management. Results The research involved a total of 172 individuals. During the pandemic (April to September 2020), 91 of these participants underwent surgery, which is more than the 81 individuals who had surgery during the same period the previous year (April to September 2019). Preoperative C-reactive protein levels were significantly higher in the pandemic group (P = 0.0455). The time from admission to surgery was shorter in the pandemic group (7.5 ± 4.6 vs. 5.8 ± 4.9; P = 0.0155). The overall operative and laparoscopic operative times were longer in the pandemic group (65 vs. 71 minutes, P = 0.391, and 55 vs. 62 minutes, P = 0.1424, respectively). However, these differences were not statistically significant. The number of patients presenting with complicated appendicitis was significantly higher in the pandemic group than in the nonpandemic group (44.4% vs. 61.4%; P = 0.034). The length of stay was shorter in the pandemic group (P = 0.53). Conclusions Our study suggests that surgery for acute appendicitis remains safe and feasible during the COVID-19 pandemic, with comparable outcomes. However, we noted an increase in the number of patients presenting with complicated appendicitis, possibly influenced by national pandemic guidelines in the United Kingdom. Despite this trend, our findings affirm the continued effectiveness of surgical management for acute appendicitis during the pandemic, highlighting the adaptability of healthcare systems in addressing emergent medical needs under challenging circumstances.
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Affiliation(s)
- Akshay Bavikatte
- General and Colorectal Surgery, West Suffolk Hospital NHS Trust, Bury St. Edmunds, GBR
| | - Sanad Isswiasi
- General Surgery, West Suffolk Hospital NHS Trust, Bury St. Edmunds, GBR
| | - Kyrllos Farag
- General Surgery, West Suffolk Hospital NHS Trust, Bury St. Edmunds, GBR
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Johnston DB, Coleman HG, Colvin D, Lawther S, Loughrey MB. Impact of COVID-19 on acute appendicitis presentation, management and pathology findings in adult and paediatric populations. PLoS One 2024; 19:e0300357. [PMID: 38630774 PMCID: PMC11023581 DOI: 10.1371/journal.pone.0300357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND We investigated the impact of the COVID-19 pandemic on trends of presentation, management and pathology findings in patients who underwent an appendicectomy for suspected acute appendicitis. METHOD The retrospective study reviewed patients (n = 939 adults and n = 329 children) who had an appendicectomy performed for suspected acute appendicitis and histopathology assessment in the Belfast Health and Social Care Trust, Northern Ireland. Pre-COVID-19 (March 2019 to February 2020) and COVID-19 Year 1 (March 2020 to February 2021) data were compared. Chi-squared tests were applied to compare timeframes. RESULTS 513 adult appendicectomies were performed in the immediate year pre-COVID-19, compared to 426 in COVID-19 Year 1, representing a 17% reduction. No such reduction was seen within the paediatric population, likely related to a change in regional paediatric referral criteria during the pandemic. When comparing COVID-19 Year 1 with pre-pandemic, fewer patients presented with <24 hours of symptoms (45% v 53%, p = 0.005), and there was greater use of pre-operative computed tomography imaging in adults (63.2% v 48.7%, p<0.001). Fewer adult and paediatric cases of simple acute appendicitis and non-diagnostic specimens, with relative increased proportions of perforated acute appendicitis, were observed in COVID-19 Year 1 compared with pre-pandemic. No absolute increase in perforated acute appendicitis cases was observed in adults. CONCLUSION Year 1 of the COVID-19 pandemic was associated with delayed presentation of acute appendicitis in adults and children. In adults, an overall reduction in appendicectomy operations, increased use of pre-operative diagnostic imaging, and fewer specimens showing simple acute appendicitis or non-diagnostic features, collectively support appropriate restriction of surgery for those patients with a more certain acute appendicitis diagnosis.
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Affiliation(s)
- Dorothy B. Johnston
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Helen G. Coleman
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - David Colvin
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Suzanne Lawther
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Maurice B. Loughrey
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
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Rafaqat W, Abiad M, Lagazzi E, Argandykov D, Proaño-Zamudio JA, Velmahos GC, Hwabejire JO, Parks JJ, Luckhurst CM, DeWane MP. Analyzing the Impact of Concomitant COVID-19 Infection on Outcomes in Trauma Patients. Am Surg 2024:31348241246176. [PMID: 38613452 DOI: 10.1177/00031348241246176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
BACKGROUND The impact of COVID-19 infection at the time of traumatic injury remains understudied. Previous studies demonstrate that the rate of COVID-19 vaccination among trauma patients remains lower than in the general population. This study aims to understand the impact of concomitant COVID-19 infection on outcomes in trauma patients. METHODS We conducted a retrospective cohort study of patients ≥18 years old admitted to a level I trauma center from March 2020 to December 2022. Patients tested for COVID-19 infection using a rapid antigen/PCR test were included. We matched patients using 2:1 propensity accounting for age, gender, race, comorbidities, vaccination status, injury severity score (ISS), type and mechanism of injury, and GCS at arrival. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), Intensive Care Unit (ICU) LOS, 30-day readmission, and major complications. RESULTS Of the 4448 patients included, 168 (3.8%) were positive (COV+). Compared with COVID-19-negative (COV-) patients, COV+ patients were similar in age, sex, BMI, ISS, type of injury, and regional AIS. The proportion of White and non-Hispanic patients was higher in COV- patients. Following matching, 154 COV+ and 308 COV- patients were identified. COVID-19-positive patients had a higher rate of mortality (7.8% vs 2.6%; P = .010), major complications (15.6% vs 8.4%; P = .020), and thrombotic complications (3.9% vs .6%; P = .012). Patients also had a longer hospital LOS (median, 9 vs 5 days; P < .001) and ICU LOS (median, 5 vs 3 days; P = .025). CONCLUSIONS Trauma patients with concomitant COVID-19 infection have higher mortality and morbidity in the matched population. Focused interventions aimed at recognizing this high-risk group and preventing COVID-19 infection within it should be undertaken.
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Affiliation(s)
- Wardah Rafaqat
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - May Abiad
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Emanuele Lagazzi
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Dias Argandykov
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Jefferson A Proaño-Zamudio
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - John O Hwabejire
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan J Parks
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Casey M Luckhurst
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Michael P DeWane
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
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Layrisse Landaeta V, Dincheva GR, Hong JS, Kim A, Verzani Z, Yuan V, Zhang C, Chao SY. Acute Appendicitis in the Epicenter of the COVID-19 Pandemic: A New York City Single-Center Experience. Am Surg 2024; 90:780-787. [PMID: 37915247 DOI: 10.1177/00031348231204909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Appendectomy is the gold standard for simple appendicitis. During the coronavirus-19 pandemic, it was estimated that appendectomies in the United States decreased by 24%. We aimed to describe trends in acute appendicitis management at a center located in one of the largest epicenters of the pandemic. METHODS This is a retrospective cohort study in a single institution located in Queens, New York, of patients who presented with acute appendicitis. A pre-COVID time period, March-June 2019, was compared to peak-COVID, March-June 2020, and late-COVID, March-June 2021. RESULTS Of the 382 patients admitted with appendicitis during the time periods, 164 were admitted pre-COVID. Appendicitis presentations decreased by 44% during peak-COVID and 23% in late-COVID. Patients were younger during peak-COVID compared to pre-COVID (39 vs 34 years old, P = .036). Incidence of complicated appendicitis in pre-, peak-, and late-COVID was equivalent (41% vs 46% vs 45%) and operative management was similar (85% vs 76% vs 79%). Non-operative patients had shorter lengths of stay (pre- vs peak-COVID: 4.6 vs 2.9 days, P = .006). Readmission rates were similar between the cohorts across time periods. CONCLUSIONS During peak-COVID, there was a significant decrease in presentation of acute appendicitis but clinical presentation and outcomes remained similar between the cohorts. Patients who were managed non-operatively may be discharged earlier without increased rates of readmissions.
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Affiliation(s)
| | | | - Julie S Hong
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Angelina Kim
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Zoe Verzani
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Victoria Yuan
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Charles Zhang
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Steven Y Chao
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
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Vevaud K, Dallocchio A, Dumoitier N, Laspougeas A, Labrunie A, Belgacem A, Fourcade L, Ballouhey Q. A prospective study to evaluate the contribution of the pediatric appendicitis score in the decision process. BMC Pediatr 2024; 24:131. [PMID: 38373918 PMCID: PMC10875762 DOI: 10.1186/s12887-024-04619-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/03/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The objective of this study was to assess the likelihood of acute appendicitis (AA) in children presenting with abdominal symptoms at the emergency department (ED), based on their prior primary care (PC) consultation history. METHODS Between February and June 2021, we prospectively enrolled all children presenting at the ED with acute abdominal pain indicative of possible acute appendicitis (AA). Subsequently, they were categorized into three groups: those assessed by a PC physician (PG), those brought in by their family without a prior consultation (FG), and those admitted after a PC consultation without being assessed as such. The primary objective was to assess the probability of AA diagnosis using the Pediatric Appendicitis Score (PAS). Secondary objectives included analyzing PAS and C-reactive protein (CRP) levels based on the duration of pain and final diagnoses. RESULTS 124 children were enrolled in the study (PG, n = 56; FG, n = 55; NG, n = 13). Among them, 29 patients (23.4%) were diagnosed with AA, with 13 cases (23.2%) from the PG and 14 cases (25.4%) from the FG. The mean PAS scores for AA cases from the PG and FG were 6.69 ± 1.75 and 7.57 ± 1.6, respectively, (p = 0.3340). Both PAS scores and CRP levels showed a significant correlation with AA severity. No cases of AA were observed with PAS scores < 4. CONCLUSIONS There was no significant difference in PAS scores between patients addressed by PG and FG, even though PAS scores tended to be higher for patients with AA. We propose a new decision-making algorithm for PC practice, which incorporates inflammatory markers and pain duration. TRIAL REGISTRATION Institutional Ethics Committee registration number: 447-2021-103 (10/01/2021). CLINICAL TRIALS REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT04885335 (Registered on 13/05/2021).
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Affiliation(s)
- Kevin Vevaud
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France
| | - Aymeric Dallocchio
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France
| | - Nathalie Dumoitier
- Département universitaire de médecine Générale, Faculté de médecine de Limoges, 2 rue du Docteur Marcland, Limoges Cedex, 87042, France
| | - Alban Laspougeas
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France
| | - Anaïs Labrunie
- Biostatistics and Research Methodology (CEBIMER), Limoges University Hospital, 2 rue du Docteur Marcland, Limoges Cedex, 87042, France
| | - Alexis Belgacem
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France
| | - Laurent Fourcade
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France
| | - Quentin Ballouhey
- Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France.
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Hassanieh J, Zalaquett N, Khazzeka A, El Ghazal R, Riachi M, Habib S, Zaghal A. The impact of the COVID-19 pandemic on acute appendicitis patients in a tertiary care center in Lebanon. BMC Surg 2024; 24:18. [PMID: 38191368 PMCID: PMC10775468 DOI: 10.1186/s12893-023-02273-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/23/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION With it becoming a global pandemic, the coronavirus disease of 2019 (COVID-19) imposed public health restraints that hampered patient's presentation to hospitals. In Lebanon, little is known about the presentation patterns of acute appendicitis (AA) patients among different population groups during the COVID-19. Therefore, this study aims to assess the effects of the COVID-19 pandemic on the rates of cases seen during the pandemic period, the adopted management strategies, and evaluate the patient outcomes compared to presentations from previous years. METHODS This is a retrospective, observational cohort study with no interventional procedures. All patients presented to our tertiary health care center were diagnosed with AA between February 2019 and February 2021 comprised the study analysis. We divided our patients into the pre-pandemic period cohort March 1st, 2019, till February 29th, 2020, and the pandemic period cohort March 1st 2020 till March 1st 2021. RESULTS We collected data retrospectively from 342 patients: 201 patients presented in the pre-pandemic period and 141 during the pandemic period. Male predominance was seen in both cohorts (51.7% and 58.9% respectively). A decrease in the number of AA cases was seen during the pandemic, however, the duration of symptoms before presentation was similar in both cohorts (p = 0.382) Additionally, the number of complicated appendicitis cases was not different between cohorts. The main imaging modality was CT in both groups with no statistically significant difference in the type of imaging between them (p = 0.398). Further, the predominant treatment modality remained surgery during the pandemic, with no difference between both periods (p = 0.200), and no statistically significant difference in the type of surgery performed as laparoscopic surgery remained the most common surgery type in the pandemic period (p = 0.43). Finally, no extra surgical and post-surgical complications were identified. CONCLUSION In conclusion, our study is an example of how the COVID-19 pandemic did not significantly affect patients presenting for AA. Despite the COVID-19-related restrictions, Lebanese patients with worrying symptoms were presenting to the emergency department and the American University of Beirut Medical Center was providing them with the standards of care. Our study mirrors the Lebanese experience and gives an example of a population that focused more on their current symptoms than the fear of acquiring the COVID-19 virus. Further research is needed to assess whether this was the correct approach during these times.
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Affiliation(s)
- Joelle Hassanieh
- Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Nader Zalaquett
- Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Alicia Khazzeka
- Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Ryan El Ghazal
- Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Mansour Riachi
- Department of Anatomy, Cell Biology, and Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
| | - Salim Habib
- Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Ahmad Zaghal
- Department of Surgery, American University of Beirut-Medical Center, Beirut, Lebanon.
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Gil C, Beyer-Bergeot L, Sabbagh C, Zerbib P, Bridoux V, Manceau G, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiori L, Rebibo L, Christou N, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Giger U, Alves A, Ouaissi M. Impact of the first wave of COVID-19 epidemy on the surgical management of sigmoid diverticular disease in France: National French retrospective study. Int J Colorectal Dis 2023; 38:276. [PMID: 38040936 DOI: 10.1007/s00384-023-04564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To analyze the surgical management of sigmoid diverticular disease (SDD) before, during, and after the first containment rules (CR) for the first wave of COVID-19. METHODS From the French Surgical Association multicenter series, this study included all patients operated on between January 2018 and September 2021. Three groups were compared: A (before CR period: 01/01/18-03/16/20), B (CR period: 03/17/20-05/03/20), and C (post CR period: 05/04/20-09/30/21). RESULTS A total of 1965 patients (A n = 1517, B n = 52, C n = 396) were included. The A group had significantly more previous SDD compared to the two other groups (p = 0.007), especially complicated (p = 0.0004). The rate of peritonitis was significantly higher in the B (46.1%) and C (38.4%) groups compared to the A group (31.7%) (p = 0.034 and p = 0.014). As regards surgical treatment, Hartmann's procedure was more often performed in the B group (44.2%, vs A 25.5% and C 26.8%, p = 0.01). Mortality at 90 days was significantly higher in the B group (9.6%, vs A 4% and C 6.3%, p = 0.034). This difference was also significant between the A and B groups (p = 0.048), as well as between the A and C groups (p = 0.05). There was no significant difference between the three groups in terms of postoperative morbidity. CONCLUSION This study shows that the management of SDD was impacted by COVID-19 at CR, but also after and until September 2021, both on the initial clinical presentation and on postoperative mortality.
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Affiliation(s)
- Camille Gil
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Avenue de la République, F37044 Tours, France
| | - Laura Beyer-Bergeot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - Charles Sabbagh
- Department of Surgery Department, Amiens University Hospital, Amiens, France
| | - Philippe Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, Lille, France
| | - Valérie Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - Gilles Manceau
- Department of digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, univeristy Paris Cité, Paris, France
| | - Yves Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly/Seine, France
| | - Etienne Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - Aurélien Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - Iman Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - Martin Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - Manon Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - Alexandre Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - Benjamin Menahem
- Unité INSERM UMR 1086 ANTICIPE Registre spécialisé des Tumeurs Digestives du calvados-Service de chirurgie digestive, Université de Caen Normandie 14000, Caen, France
| | - Clarisse Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - Catherine Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - Bodgan Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - Camille Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Yassine Eid
- Department of Digestive Surgery, Polyclinique de Lisieux, Lisieux, France
| | - Emilie Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - Anais Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | | | - Léon Maggiori
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - Lionel Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Niki Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - Ali Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - Cécile Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | | | - François Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - Christophe Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Sorbonne Paris Nord University, Paris, France
| | - Jean Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - Alexis Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Martin Bertrand
- Department of Digestive Surgery, Universitary Hospital of Nîmes, Nîmes, France
| | - Damien Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - Benoit Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Urs Giger
- Fliedner Fachhochschule, University of Applied Sciences, Düsseldorf, Germany
| | - Arnaud Alves
- Unité INSERM UMR 1086 ANTICIPE Registre spécialisé des Tumeurs Digestives du calvados-Service de chirurgie digestive, Université de Caen Normandie 14000, Caen, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Avenue de la République, F37044 Tours, France.
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10
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Kupietzky A, Finkin M, Dover R, Eliezer Lourie NE, Mordechai-Heyn T, Juster EY, Mazeh H, Mizrahi I. Higher Rates of Complicated Appendicitis During the COVID-19 Pandemic: A Year-to-Year Analysis. J Surg Res 2023; 290:304-309. [PMID: 37329625 PMCID: PMC10208264 DOI: 10.1016/j.jss.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/03/2023] [Accepted: 05/12/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The COVID-19 pandemic impacted presentation, management strategies, and patient outcomes of numerous medical conditions. The aim of this study is to perform a year-to-year comparison of clinical outcomes of patients with acute appendicitis (AA) before and during the pandemic. METHODS Patients treated for AA during the initial 12-mo period of the pandemic at our institute were compared to those treated for AA during the 12-mo period before. Clinical and laboratory parameters, treatment strategies, intraoperative findings, pathology reports, and postoperative outcomes were compared. RESULTS During the study period, 541 patients presented with AA. The median (interquartile range) age was 28 (21-40) y and 292 (54%) were males. 262 (48%) patients presented during the pre-COVID-19 period, while 279 patients (52%) presented during the COVID 19 pandemic. The groups were comparable for baseline clinical data and imaging results upon index admission. There was no significant difference in rate of nonoperative treatment between the Pre-COVID-19 and During-COVID-19 eras (51% versus 53%, P = 0.6) as well as the success rate of such treatment (95.4% versus 96.4%, P = 0.3). Significantly more patients presented with a periappendicular abscess during COVID-19 (4.6% versus 1.1%, P = 0.01) and median (interquartile range) operative time was significantly longer (78 (61-90) versus 32.5 (27-45) min, P < 0.001). Pathology reports revealed a higher rate of perforated appendicitis during COVID-19 (27.4% versus 10.2%, P < 0.001). CONCLUSIONS Patients with AA present with higher rates of perforated and complicated appendicitis during the COVID-19 pandemic. The success rates of nonoperative management in selected patients with noncomplicated AA did not change during the pandemic and is a safe, feasible, option.
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Affiliation(s)
- Amram Kupietzky
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Miriam Finkin
- Faculty of Medicine, Department of Military Medicine and "Tzameret", Hebrew University of Jerusalem and Medical Corps, Israel Defense Forces, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roi Dover
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nachum Emil Eliezer Lourie
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tzlil Mordechai-Heyn
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Yonathan Juster
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Haggi Mazeh
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ido Mizrahi
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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11
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Pantalos G, Papachristidou S, Mavrigiannaki E, Zavras N, Vaos G. Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review. Diagnostics (Basel) 2023; 13:2571. [PMID: 37568934 PMCID: PMC10417690 DOI: 10.3390/diagnostics13152571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Global pandemics cause health system disruptions. The inadvertent disruption in surgical emergency care during the Coronavirus Disease 2019 (COVID-19) pandemic has been the topic of several published studies. Our aim was to summarize the reasons that led to the delayed diagnosis of pediatric appendicitis during the COVID-19 era. This systematic literature search evaluated studies containing pediatric appendicitis patient data regarding outcomes, times to hospital admission or times from symptom onset to emergency department visit. Studies elucidating reasons for delays in the management of pediatric appendicitis were also reviewed. Ultimately, 42 studies were included. Several reasons for delayed diagnosis are analyzed such as changes to public health measures, fear of exposure to COVID-19, increased use of telemedicine, COVID-19 infection with concurrent acute appendicitis, recurrence of appendicitis after non-operative management and increased time to intraoperative diagnosis. Time to hospital admission in conjunction with patient outcomes was extracted and analyzed as an indicative measure of delayed management. Delayed diagnosis of acute appendicitis has been documented in many studies with various effects on outcomes. Suspicion of pediatric acute appendicitis must always lead to prompt medical examination, regardless of pandemic status. Telemedicine can be valuable if properly applied. Data from this era can guide future health system policies.
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Affiliation(s)
- George Pantalos
- Pediatric Intensive Care Unit, Penteli General Children’s Hospital, 15236 Athens, Greece
| | - Smaragda Papachristidou
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, P. & A. Kyriakou Children’s Hospital, 11527 Athens, Greece;
| | - Eleftheria Mavrigiannaki
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
| | - Nikolaos Zavras
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
| | - George Vaos
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
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12
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Nguyen HV, Tran LH, Ly TH, Pham QT, Pham VQ, Tran HN, Trinh LT, Dinh TT, Pham DT, Mai Phan TA. Impact of the COVID-19 Pandemic on the Severity and Early Postoperative Outcomes of Acute Appendicitis. Cureus 2023; 15:e42923. [PMID: 37546691 PMCID: PMC10400342 DOI: 10.7759/cureus.42923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic caused changes in surgical practice. For acute appendicitis (AA), measures to control the pandemic might hinder patients from seeking medical care timely, resulting in increasing severity, postoperative complications, and mortality. This study aimed to investigate whether the COVID-19 pandemic had a negative impact on the severity and postoperative outcomes of patients with AA. Methodology We retrospectively reviewed medical records of AA patients treated operatively at Nhan Dan Gia Dinh Hospital hospital from June 1st to September 30th in three consecutive years: pre-pandemic (2019)/Group 1, minor waves (2020)/Group 2, and major wave (2021)/Group 3 (2021). Data were collected focusing on the duration of symptoms, severity of AA, time from admission to operation, postoperative complications, and mortality. Results There were 1,055 patients, including 452 patients in Group 1, 409 in Group 2, and 194 in Group 3. The overall number of patients decreased mainly in non-complicated AA. The percentages of hospital admission after 24 hours gradually increased (20.8%, 27.9%, and 43.8%, p < 0.05). The percentages of complicated AA in Group 2 and Group 3 were statistically higher than in Group 1 (39% and 55% vs. 31%, p < 0.05). Waiting time for operation increased to five hours during the major wave. Laparoscopic appendectomy was performed in 98-99% of AA patients during the pandemic, with an early postoperative complication rate of 5-9% and a mortality rate of 0.2-1%. Conclusions Although the percentages of hospital admission after 24 hours and complicated AA increased, laparoscopic appendectomy was still feasible and effective and should be maintained as the standard management for AA during the COVID-19 pandemic.
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Affiliation(s)
- Hai V Nguyen
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Loc H Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Tuan H Ly
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Quang T Pham
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, VNM
| | - Vu Q Pham
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Ha N Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Loc T Trinh
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Thien T Dinh
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Dinh T Pham
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Tuong Anh Mai Phan
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
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13
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Colosimo C, Ingram B, Weaver J, Offner P, Yon J. Increased Complications of Emergent Surgical Procedures During the First Wave of COVID-19. J Surg Res 2023; 286:16-22. [PMID: 36731261 PMCID: PMC9868353 DOI: 10.1016/j.jss.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 12/31/2022] [Accepted: 01/08/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Based on recommendations by CMS elective surgery was stopped during the first wave of COVID-19. Despite hospitals being open for emergent surgery, there were some studies that showed a decrease in surgical volume. METHODS A retrospective analysis for all surgeries from 185 affiliated hospitals from the first wave of the COVID-19 pandemic (March 2020 to May 2020) and as a comparison the previous year, March 2019 to May 2019 were obtained. Five surgeries were further analyzed: appendectomies, cholecystectomies, craniotomies, exploratory laparotomies, and endoscopic retrograde cholangiopancreatographies (ERCPs). RESULTS Between March 2019 and May 2019, 326,726 surgeries were performed, and between March 2020 and May 2020, 237,809 surgeries were performed. The highest specialty for both years was gastroenterology. In 2020, 15.7% of the patients were admitted to the ICU versus 13.7% in 2019. For appendectomies, cholecystectomies, craniotomies, exploratory laparotomies and ERCPs, there was an increase from 2019 to 2020 in acute kidney injuries rate, infection, systemic inflammatory response syndrome (SIRS), and sepsis. All the changes in surgical volumes for the five surgeries from 2019 to 2020 were significant. For appendectomy, the statistically significant complications were infection and SIRS and sepsis. CONCLUSIONS Across the board, there was a decrease in surgical volume during the COVID-19 pandemic first wave. There was a statistically significant decrease in appendectomy, cholecystectomy, exploratory laparotomy, craniotomy, and ERCP. For all five surgeries, we did see an increase in mortality rates and several complications. The only statistically significant complications were infection and SIRS and sepsis, for appendectomy.
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Affiliation(s)
| | | | - John Weaver
- Sky Ridge Medical Center, Lone Tree, Colorado
| | | | - James Yon
- New Hanover Regional Medical Center, Wilmington, North Carolina
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14
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Del Giorgio F, Habti M, Merckx J, Kaufman JS, Gravel J, Piché N, Osmanlliu E, Drouin O. Investigating changes in incidence and severity of pediatric appendicitis during the COVID-19 pandemic in Canada: an interrupted time series analysis. World J Pediatr 2023; 19:288-292. [PMID: 36574211 PMCID: PMC9792923 DOI: 10.1007/s12519-022-00656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/16/2022] [Indexed: 12/28/2022]
Affiliation(s)
| | - Merieme Habti
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Joanna Merckx
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Jay S Kaufman
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Nelson Piché
- Department of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Esli Osmanlliu
- Division of Pediatric Emergency Surgery, Montreal Children's Hospital, Montreal, Canada
| | - Olivier Drouin
- Department of Social and Preventative Medicine, Université de Montréal, Montreal, Canada.
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada.
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15
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Cheng O, Hu JY, Hong J, Sarad N, Zenilman ME, Chen CC, Fahoum B, Lee RS. Operative Management of Acute Appendicitis is Safe During the COVID-19 Pandemic Shutdown. J Surg Res 2023; 287:117-123. [PMID: 36924622 PMCID: PMC9892322 DOI: 10.1016/j.jss.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/15/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION In the spring of 2020, New York City was one of the first epicenters of the COVID outbreak. In this study, we evaluate the incidence and treatment of appendicitis in two New York City community hospitals during the COVID pandemic. METHODS This retrospective study focused on the incidence and outcome of acute appendicitis in the adult population (>18 y old) during peak-COVID periods (March 16, 2020,-June 15, 2020) compared to pre-COVID and post-COVID periods. We compared the number of patients who underwent operative versus nonoperative management, patient demographics, length of stay (LOS), complications, and readmission rates within these time periods. Data are presented as mean ± standard deviation (analysis of variance). RESULTS From January 1, 2020 to December 31, 2020, 393 patients presented with acute appendicitis and 321 (81.7%) were treated operatively, compared to 441 total and 366 treated operatively (83%) in 2019 (P = 0.88). During the COVID outbreak, fewer patients presented with appendicitis (mean 6.9 ± 1 pre-COVID case/week, 4.4 ± 2.4 peak-COVID cases/week and 7.6 ± 0.65 post-COVID cases/week, P = 0.018) with no significant difference in the pre-COVID and post-COVID period. There was no difference in LOS between the pre-, peak-, and post-COVID periods with a median of 1 for all the three, (interquartile range (IQR): 0.8-2, 0.6-2, 0.6-2, respectively, P = 0.43). Additionally, there was no difference in 30-day readmission rates (4.2%, 0%, 3.9%, P = 0.99) and postoperative complications (4.2%, 0%, 2.9%, P = 0.98). CONCLUSIONS During peak-COVID, there was a significant reduction in the number of patients who presented with acute appendicitis without a post rebound increase in presentation. Those who presented during peak-COVID were able to undergo operative management safely, without affecting LOS or postoperative complications.
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Affiliation(s)
- Olivia Cheng
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York.
| | - James Y Hu
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Julie Hong
- New York-Presbyterian Queens Hospital, Flushing, New York
| | - Nakia Sarad
- New York-Presbyterian Queens Hospital, Flushing, New York
| | | | | | - Bashar Fahoum
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Roseanna S Lee
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
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16
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Boike S, Mir M, Olson H, Cole D, Rauf I, Surani S, Khan SA. Perioperative management of emergency and elective surgeries during the pandemic. Hosp Pract (1995) 2023; 51:12-17. [PMID: 36629125 DOI: 10.1080/21548331.2023.2166746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The effects of the 2019 novel coronavirus, SARS-CoV-2, and its associated pandemic are complex and widespread. It has permeated all aspects of daily life around the world. Unsurprisingly, it also had significant impacts on proceedings within hospitals around the world as well. Most notably, the multiple waves of the pandemic have each had untoward effects on surgical productivity within hospital systems. More specifically, the disruption of surgical procedures has impacted both emergent and elective cases. In the context of emergent procedures, hospital systems have had to reevaluate how they define 'emergent,' forcing them to determine which cases could not be rescheduled versus those that could. Elective procedures, on the other hand, were nearly halted altogether in the initial pandemic waves. If these were not completely stopped in some places, then they were greatly reduced. This paper will serve to describe the effect the pandemic has had on the proceedings of both elective and emergent surgeries. It will also describe how we have reevaluated and changed the way we define 'emergent' surgeries and describe the potential implications of this. We will also describe literature that speaks to the implications of the delay of elective procedures. Additionally, the cost implications of fewer surgical procedures performed will be discussed. Finally, we will describe literature that has established protocols for scheduling surgeries in waves of the pandemic, how these have evolved over time, and how they have created confusion for hospital systems navigating the pandemic.
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Affiliation(s)
- Sydney Boike
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Mikael Mir
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Holly Olson
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Delaney Cole
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ibtisam Rauf
- St. George's School of Medicine, University Centre Grenada, West Indies, Grenada
| | - Salim Surani
- College Station, Texas A&M University, TX, USA.,Research Collaborator, Mayo Clinic, Rochester, MN, USA
| | - Syed Anjum Khan
- Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, USA
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17
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Blohs M, Mahnert A, Brunnader K, Flucher C, Castellani C, Till H, Singer G, Moissl-Eichinger C. Acute appendicitis manifests as two microbiome state types with oral pathogens influencing severity. Gut Microbes 2023; 15:2145845. [PMID: 36691230 PMCID: PMC9879201 DOI: 10.1080/19490976.2022.2145845] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/02/2022] [Indexed: 01/25/2023] Open
Abstract
Mounting evidence suggests that acute appendicitis (AA) is not one but two diseases: complicated appendicitis, which is associated with necrosis leading to perforation or periappendicular abscess, and uncomplicated appendicitis, which does not necessarily result in perforation. Even though AA is the most frequent cause of surgery from abdominal pain, little is known about the origins and etiopathogenesis of this disease, much less regarding the different disease types. In this study, we investigated the microbiome (inter-domain amplicon and metagenome sequencing) of samples from the appendix, rectum and peritoneum of 60 children and adolescents with AA to assess the composition and potential function of bacteria, archaea and fungi. The analysis of the appendix microbial community revealed a shift depending on the severity of the AA. This shift was reflected by two major community state types that represented the complicated and uncomplicated cases. We could demonstrate that complicated, but not uncomplicated, appendicitis is associated with a significant local expansion of oral, bacterial pathogens in the appendix, most strongly influenced by necrotizing Fusobacterium spp., Porphyromonas and Parvimonas. Uncomplicated appendicitis, however, was characterized by gut-associated microbiomes. Our findings support the hypothesis that two disease types exist in AA, which cannot be distinguished beyond doubt using standard clinical characterization methods or by analysis of the patient's rectal microbiome. An advanced microbiome diagnosis, however, could improve non-surgical treatment of uncomplicated AA.
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Affiliation(s)
- Marcus Blohs
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz8010, Austria
| | - Alexander Mahnert
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz8010, Austria
| | - Kevin Brunnader
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz8036, Austria
| | - Christina Flucher
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz8036, Austria
| | - Christoph Castellani
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz8036, Austria
| | - Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz8036, Austria
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz8036, Austria
| | - Christine Moissl-Eichinger
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz8010, Austria
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18
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Chrysos A, Amygdalos I, Nunes P, Haselow G, Lioupis K, Rosch R, Eickhoff RM, Wiltberger G, Neumann UP, Lambertz A. The impact of the COVID-19 outbreak on emergency general surgery in the first German "hotspot region" Aachen-Heinsberg-A multicentre retrospective cohort study. PLoS One 2023; 18:e0280867. [PMID: 36696422 PMCID: PMC9876361 DOI: 10.1371/journal.pone.0280867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
This study aimed to observe the impact of the COVID-19 outbreak on acute general surgery in the first German "hotspot" regions of Heinsberg and Aachen, during the first months of the pandemic. The incidence and severity of acute appendicitis, acute cholecystitis and mechanical bowel obstruction, were compared between March and May 2020 and a control period (same months of the previous three years). Pre-, intra- and postoperative data was compared between three regional hospitals of Heinsberg and the closest maximum care, university hospital. A total of 592 operated patients were included, 141 belonging to the pandemic cohort and 451 to the historic cohort. The pandemic group showed higher rates of clinical peritonitis (38% vs. 27%, p = 0.015), higher rates of mean white blood cell count (13.2±4.4 /nl vs. 12.3±4.7 /nl, p = 0.044) and mean C-reactive protein (60.3±81.1 mg/l vs. 44.4±72.6 mg/l, p = 0.015) preoperatively. Specifically in patients with acute appendicitis, there were less patients with catarrhal appendicitis (23% vs. 35%, p = 0.021) and a tendency towards more advanced histological findings in the pandemic cohort. In the university hospital, a 42% reduction in acute operated cases was observed at the onset of the pandemic (n = 30 in 2020 vs. n = 52 in 2019), whereas in the peripheral hospitals of Heinsberg there was only a 10% reduction (n = 111 in 2020 vs. n = 123 in 2019). The onset of the COVID-19 pandemic in our region was accompanied by advanced preoperative and intraoperative findings in patients undergoing emergency general surgery. A greater reduction in acute operated surgical cases was observed at the university hospital, in contrast to the smaller hospitals of Heinsberg, suggesting a possible shift of emergency patients, requiring immediate operation, from maximum care hospital to the periphery.
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Affiliation(s)
- Alexandros Chrysos
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
- * E-mail:
| | - Iakovos Amygdalos
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
| | - Priscila Nunes
- Department of General Surgery, St. Elisabeth-Hospital, Geilenkirchen, Nordrhein-Westfalen, Germany
| | - Guenter Haselow
- Department of General Surgery, St. Elisabeth-Hospital, Geilenkirchen, Nordrhein-Westfalen, Germany
| | - Konstantinos Lioupis
- Department of General Surgery, Municipal Hospital, Heinsberg, Nordrhein-Westfalen, Germany
| | - Raphael Rosch
- Department of General Surgery, Hermann-Josef-Hospital, Erkelenz, Nordrhein-Westfalen, Germany
| | - Roman Marius Eickhoff
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
| | - Georg Wiltberger
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Nordrhein-Westfalen, Germany
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19
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Öztaş T, Bilici S, Dursun A. Has the frequency of complicated appendicitis changed in children in the first year of the COVID-19 pandemic? ANNALS OF PEDIATRIC SURGERY 2023; 19:3. [PMID: 36644328 PMCID: PMC9831875 DOI: 10.1186/s43159-022-00235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background The COVID-19 pandemic period suggests that the rate of complications may have increased in patients requiring surgical treatment due to the fact that they could not come to the hospital at the onset of the symptom. This study aims to evaluate the difference in the frequency of complicated appendicitis and postoperative complications in the COVID-19 pandemic.Patients included those who underwent appendectomy in 1 year before the COVID-19 pandemic and in the first year of the pandemic. The patients were categorized into two groups: pre-pandemic and pandemic periods. Clinical and histopathology results were compared between the pre-pandemic and pandemic periods. Results A total of 407 patients were included in the study, 207 of whom were included during the pre-pandemic and 200 of whom during the pandemic period. The mean time to hospital admission after the onset of symptoms was 1.3 ± 0.9 days, pre-pandemic, and 1.4 ± 0.8 days during the pandemic group. In the pre-pandemic group, 0.4% intrabdominal abscess developed and 37.5% complicated appendicitis was detected. In the pandemic group, it was found that there were 1% abscess, 0.5% wound infection, 0.5% brid ileus, and 31.9% complicated appendicitis. The pre-pandemic group length of hospitalization was 2.4 ± 0.8 days, and the pandemic was 2.1 ± 0.9 days There was no difference between pre-pandemic and pandemic groups in terms of age, gender, white blood cell count, duration of symptoms, postoperative complications and frequency of complicated appendicitis, and duration of hospitalization. Conclusions In the first year of the COVID-19 pandemic, we found that the rate of complicated appendicitis and postoperative complications were not different from pre-pandemic.
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Affiliation(s)
- Tülin Öztaş
- grid.461868.50000 0004 0454 9842Department of Pediatric Surgery, University of Health Sciences Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Salim Bilici
- grid.461868.50000 0004 0454 9842Department of Pediatric Surgery, University of Health Sciences Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Ahmet Dursun
- grid.461868.50000 0004 0454 9842Department of Pediatric Surgery, University of Health Sciences Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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20
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Winicki NM, Dahan A, Maheshwari S, Crowley B, Gelbard R, Burruss S. Racial and ethnic variation in emergent surgical care and outcomes during the COVID-19 pandemic: post hoc analysis of an EAST MCT. Trauma Surg Acute Care Open 2022; 7:e001023. [PMID: 36532692 PMCID: PMC9742842 DOI: 10.1136/tsaco-2022-001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives The COVID-19 pandemic highlighted concerns regarding the equity of medical care. We evaluated associations between race/ethnicity, timing of hospital presentation and outcomes of acute appendicitis (AP) and acute cholecystitis (AC) during the initial pandemic peak. Methods Analysis was performed on a prospective, observational, multicenter study of adults with AP or AC. Patients were categorized as pre-pandemic (pre-CoV: October 2019–January 2020) or during the first pandemic peak (CoV: April 2020 through 4 months following the end of local pandemic restrictions). Patient demographics, American Association for the Surgery of Trauma (AAST) imaging/pathology grade, duration of symptoms before triage, time from triage to intervention and hospital length of stay were collected. Results A total of 2165 patients (1496 pre-CoV, 669 CoV) were included from 19 centers. Asian and Hispanic patients with AC had a longer duration of symptoms prior to presentation during CoV than pre-CoV (100.6 hours vs 37.5 hours, p<0.01 and 85.7 hours vs 52.5 hours, p<0.05, respectively) and presented later during CoV than Black or White patients (34.3 and 37.9 hours, p<0.01). During CoV, Asian patients presented with higher AAST pathology grade for AP compared with pre-CoV (1.90 vs 1.26, p<0.01). Asian and Hispanic patients presented with higher AAST pathology grade for AC during CoV versus pre-CoV (2.57 vs 1.45, p<0.01, and 1.57 vs 1.20, p<0.05, respectively). Patients with AC and an AAST pathology grade of ≥3 were at higher odds of postoperative complications (OR 4.4, 95% CI 1.0 to 18.4) and AP (OR 2.8, 95% CI 1.3 to 6.0). Asian and Hispanic patients with AC had a higher risk of postoperative complications compared to White patients (Asian: OR 3.9, 95% CI 1.2 to 12.7; Hispanic: OR 3.3, 95% CI 1.2 to 8.9). Conclusion Asian and Hispanic patients had a longer duration of symptoms before hospital presentation during the initial COVID-19 peak, had higher odds of postoperative complications and more advanced pathologic disease. Level of evidence III, Prognostic/epidemiological.
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Affiliation(s)
- Nolan M Winicki
- University of California Riverside School of Medicine, Riverside, California, USA,Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Alden Dahan
- University of California Riverside School of Medicine, Riverside, California, USA,Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Somiya Maheshwari
- University of California Riverside School of Medicine, Riverside, California, USA
| | - Brandon Crowley
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rondi Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
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21
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Ayyıldız HN, Mirapoglu S, Yıldız ZA, Şahin C, Güvenç FT, Arpacık M, İlce Z. What has changed in children's appendicitis during the COVID-19 pandemic? ULUS TRAVMA ACIL CER 2022; 28:1674-1681. [PMID: 36453784 PMCID: PMC10198316 DOI: 10.14744/tjtes.2021.51000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 11/12/2021] [Indexed: 06/04/2023]
Abstract
BACKGROUND The present study aimed to investigate the changes in the course of acute appendicitis during the pandemic period by comparing the cases treated during the coronavirus disease 2019 (COVID-19) pandemic with those in the pre-pandemic period. METHODS The study was conducted with 601 children aged 1-18 years who were operated for acute appendicitis between May 1, 2019, and February 29, 2020 (Group I) and between March 1 and December 31, 2020 (Group II). The demographic and disease characteristics as well as the treatment processes were compared between the groups. RESULTS It was found that 59.1% (n=355) of the cases included in the study were in Group I and 40.9% (n=246) were in Group II. During the pandemic period; due to the concerns of families about contracting a contagious disease for both themselves and their children, and warnings by health professionals and government officials that they should not leave their homes and not come to the hospital unless there is an emergency, the time to apply to the hospital has been extended. Before the pandemic, 20.3% of the patients presented to the hospital on the 1st day of their complaints, where during the pandemic, only 2% of the patients reported to the hospital on the 1st day, and 15% presented after 4 days or more. As a result, the rate of perforated appendicitis, which was formerly 10.4%, increased to 24.8% during the pandemic period (p<0.01). During the pandemic, we operated on four patients with positive COVID-19 test results. There were no complications related to COVID-19 and surgery in our patients. CONCLUSION Concern of the current pandemic resulted in late presentation to the hospital, increase in the number of perforated appendicitis, and prolonged hospital stay.
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Affiliation(s)
- Hayriye Nihan Ayyıldız
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Semih Mirapoglu
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Zeliha Akış Yıldız
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Ceyhan Şahin
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Fatma Tuğba Güvenç
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Mehmet Arpacık
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
| | - Zekeriya İlce
- Department of Pediatric Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul-Türkiye
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22
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Altirkistani BA, Batais WT, Alsolamy RM, Sulaimani BY, Bakhidar GO. The Influence of the COVID-19 Pandemic on the Prevalence, Characteristics, Management, and Outcomes of Acute Appendicitis at the Academic Tertiary Center, Jeddah. Cureus 2022; 14:e31968. [DOI: 10.7759/cureus.31968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
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23
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Achavanuntakul C, Mahawongkajit P, Orrapin S, Auksornchat K, Boonyasatid P, Waewsri N, Moriguchi A, Kanlerd A. The Impact of the COVID-19 Pandemic on the Incidence, Severity, and Management of Acute Appendicitis: A Single Center Experience in Thailand. Emerg Med Int 2022; 2022:8324716. [PMID: 36467864 PMCID: PMC9715343 DOI: 10.1155/2022/8324716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 10/03/2023] Open
Abstract
PURPOSE For more than two years since the COVID-19 pandemic, human lives have changed, including the healthcare system. Management of acute appendicitis, the most common emergency surgical disease, has been inevitably affected. This study aimed to assess the effect of the COVID-19 pandemic on the incident rate of complicated appendicitis, management, outcome, and complication of acute appendicitis. Patients and Methods. This study was a retrospective cohort study comparing 574 patients diagnosed with acute appendicitis before the COVID-19 outbreak and 434 patients diagnosed with acute appendicitis during the COVID-19 outbreak. Patient demographic data, type of appendicitis, type of treatment, time to surgery, length of stay, cost, and complications were collected and analyzed. RESULTS During the COVID-19 pandemic, the number of patients diagnosed with acute appendicitis was reduced. CT scan usage for diagnosis was increased compared to pre-COVID-19. Most patients diagnosed with acute appendicitis received operative treatment in both groups. Median time to surgery was significantly longer during the COVID-19 pandemic, 11.93 hours compared to 9.62 hours pre-COVID-19, p-value <0.001 (relative risk 1.5, 95% CI 1.29-1.76, p value 0.041). The incidence of complicated appendicitis was not higher during COVID-19. Compared to pre-COVID-19, ICU admission rate, the use of a mechanical ventilator, length of stay, and cost increased in the univariate analysis but were not statistically significant in the multivariate analyses. Other treatment complications had no statistically significant difference. CONCLUSION The incidence of complicated appendicitis did not increase during the COVID-19 pandemic. The operation waiting time significantly increased but did not increase the rate of treatment complications in a well-prepared hospital system.
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Affiliation(s)
- Chompoonut Achavanuntakul
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Saritphat Orrapin
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Karikarn Auksornchat
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Piyapong Boonyasatid
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Nichakarn Waewsri
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Alisa Moriguchi
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
| | - Amonpon Kanlerd
- Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathumthani, Thailand
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Sukmanee J, Butchon R, Sarajan MH, Saeraneesopon T, Boonma C, Karunayawong P, Teerawattananon Y, Isaranuwatchai W. Estimating the potential overdiagnosis and overtreatment of acute appendicitis in Thailand using a secondary data analysis of service utilization before, during and after the COVID-19 lockdown policy. PLoS One 2022; 17:e0270241. [PMID: 36327258 PMCID: PMC9632900 DOI: 10.1371/journal.pone.0270241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Acute appendicitis is one of the most common surgical emergencies; however, optimal diagnosis and treatment of acute appendicitis remains challenging. We used the coronavirus disease 2019 (COVID-19) lockdown policy as a natural experiment to explore potential overdiagnosis and overtreatment of acute appendicitis in Thailand. The aim of this study was to estimate the potential overdiagnosis and overtreatment of acute appendicitis in Thailand by examining service utilization before, during, and after the COVID-19 lockdown policy. Methods A secondary data analysis of patients admitted with acute appendicitis under the Universal Coverage Scheme (UCS) in Thailand over a 6-year period between 2016 and 2021 was conducted. The trend of acute appendicitis was plotted using a 14-day rolling average of daily cases. Patient characteristics, clinical management, and outcomes were descriptively presented and compared among three study periods, namely pre-pandemic, lockdown, and post-lockdown. Results The number of overall acute appendicitis cases decreased from 25,407 during pre-pandemic to 22,006 during lockdown (13.4% reduction) and 21,245 during post-lockdown (16.4% reduction). This reduction was mostly due to a lower incidence of uncomplicated acute appendicitis, whereas cases of generalized peritonitis were scarcely affected by the pandemic. There was an increasing trend towards the usage of diagnostic computerized tomography for acute appendicitis but no significant difference in treatment modalities and complication rates. Conclusion The stable rates of generalized peritonitis and complications during the COVID-19 lockdown, despite fewer admissions overall, suggest that there may have been overdiagnosis and overtreatment of acute appendicitis in Thailand. Policy makers could use these findings to improve clinical practice for acute appendicitis in Thailand and support the efficient utilization of surgical services in the future, especially during pandemics.
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Affiliation(s)
- Jarawee Sukmanee
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Rukmanee Butchon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Myka Harun Sarajan
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Thanayut Saeraneesopon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Chulathip Boonma
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Picharee Karunayawong
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- * E-mail:
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25
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Cai X, Bi J, Zheng Z, Liu Y. Decision-making changes for patients and medical personnel in the management of acute appendicitis during the COVID-19 pandemic. BMC Emerg Med 2022; 22:170. [PMID: 36280806 PMCID: PMC9590391 DOI: 10.1186/s12873-022-00727-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute appendicitis is the most common cause of acute abdomen. During the pandemic, to contain the spread of COVID-19, there were some integral changes in the medical processes based on the pandemic prevention policy, especially regarding emergency surgery. This study was conducted to investigate whether this pandemic also impacted the decision-making for both patients and medical personnel along with the treatment outcomes. METHODS Patients of age 18 years or older who were diagnosed clinically and radiologically with acute appendicitis between Jan 1, 2017, and Dec 31, 202,0 were reviewed. The data of 1991 cases were collected and used for this study. Two groups were formed, one group before and the other group after the outbreak. The gathered data included gender, age, appendiceal fecalith, outcomes of treatment, and long-term outcomes of non-operation (8 months follow-up). We also collected details of surgical cases from the above two groups. This data also included age, gender, appendiceal fecalith, fever, jaundice, length of onset before presenting to an emergency department (ED), anesthesia, surgery, white cell count, pathology, complications, and length of stay. We compared the above data respectively and analyzed the differences. RESULTS Compared to the period before the outbreak, patient visits for acute appendicitis remarkably dropped (19.8%), but surgical cases showed no change (dropped by roughly 5%). There were significant differences (P < 0.05) in failure of non-operation(after the pandemic 8.31% vs. before pandemic 3.22%), interval appendectomy(after pandemic 6.29% vs. before pandemic 12.84%), recurrence(after pandemic 23.27% vs. before pandemic 14.46%), and outcomes of recurrence. There was a significant difference (P < 0.05) in anesthesia method, surgery way, and complications( before pandemic 4.15% vs. after pandemic9.89% P < 0.05) in patients who underwent the surgery. There was no statistical difference (P > 0.05) concerning age, gender, fever, jaundice, appendiceal fecalith, white cell count, and length of onset before presenting to the ED. CONCLUSION The current pandemic prevention policy is very effective, but some decision-making processes of doctor-patient have changed in the context of COVID-19 pandemic, that further influenced some treatment outcomes and might lead to a potential economic burden. It is essential to address the undue concern of everyone and optimize the treatment process.
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Affiliation(s)
- Xuan Cai
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, China
| | - Jingtao Bi
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, China
| | - Zhixue Zheng
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, China
| | - Yaqi Liu
- grid.414360.40000 0004 0605 7104Department of General Surgery, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, China
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Tamara-López JA, Tamara Prieto J, Sierra-Peña AF, Fernández-Ávila DGFÁ. Apendicitis aguda durante la pandemia de COVID-19: experiencia en un centro de alta complejidad en Boyacá, Colombia. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introducción. La pandemia de COVID-19 replanteó la forma de atención en los sistemas de salud, afectando todas aquellas patologías no relacionadas con infecciones respiratorias, como la apendicitis aguda. El miedo al contagio por SARS-CoV-2 y las medidas restrictivas a la movilidad pudieron aumentar el tiempo desde el inicio de los síntomas hasta la consulta al servicio de urgencias, derivando en complicaciones intra y posoperatorias.
Métodos. Estudio observacional descriptivo de corte trasversal y retrospectivo, donde se incluyeron todos los pacientes diagnosticados con apendicitis aguda llevados a apendicectomía, que fueron divididos en dos grupos, considerados pre-pandemia, desde el 1° de septiembre de 2018 al 15 de marzo de 2020, y pandemia, desde el 16 de marzo de 2020 al 30 de septiembre de 2021.
Resultados. Fueron identificados 1000 pacientes, distribuidos en 501 pacientes en el grupo pre-pandemia y 499 en el grupo pandemia. El promedio de tiempo de consulta desde el momento de inicio de síntomas hasta consulta fue de 43 horas en el grupo pre-pandemia y de casi 45 horas en el grupo pandemia.
Discusión. A pesar de las restricciones por la enfermedad causada por el nuevo coronavirus y el miedo que puede existir por el contagio, en nuestro centro no se evidenció un cambio en el manejo y presentación de los pacientes diagnosticados con apendicitis aguda.
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27
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Azadbakht M, Azadbakht S, Daniali S, Dehghani M. Comparison of the prevalence of perforated appendicitis during and before COVID19 pandemic. Ann Med Surg (Lond) 2022; 82:104785. [PMID: 36186496 PMCID: PMC9515006 DOI: 10.1016/j.amsu.2022.104785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Coronavirus disease 2019 has significantly impacted the rate of emergency department visits among patients with the non-repository disease. Patients with acute appendicitis are also likely to delay their visit to the health care center, which can lead to complications including perforated appendicitis. The aim of this study was to compare the prevalence of perforated appendicitis during the COVID19 and pre-pandemic periods. Methods This retrospective study was performed on all appendectomies performed during COVID-19, Group A, and one year earlier, Group B. A questionnaire comprising demographic variables (age, gender, occupation, education), clinical variables (white blood cell count, fever), location and type of appendicitis, the status of appendectomy, and duration of hospitalization was completed for all the patients included in the study. Results The demographic variables were not significantly different among the two groups. The perforation appendicitis rate during the COVID19 pandemic increased compared to the previous year, The difference was not statistically significant. The number of negative appendectomy in group A was significantly less compared to group B. The mean time from the onset of pain to the time of referral was significantly lesser in group A. The mean length of hospital stay in group B was longer than in group A. In terms of fever, patients with perforated appendicitis in group B had a higher fever than in group A, which was statistically significant. Conclusion A non-significant increase in the number of perforated appendicitis cases during the pandemic period. Duration of hospitalization and fever was significantly greater in pre-pandemic perforated appendicitis cases. Coronavirus disease has significantly impacted the rate of emergency department visits. Patients with acute appendicitis are also likely to delay their visit to the health care center. Which can lead to complications including perforated appendicitis. A non-significant increase in the number of perforated appendicitis cases during pandemic period.
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Affiliation(s)
- Morteza Azadbakht
- Fellowship of Advanced Laparoscopic and Bariatric Surgery, Tehran University of Medical Sciences, Tehran, Iran
- Department of Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Saleh Azadbakht
- Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- Corresponding author. Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Samira Daniali
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Dehghani
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
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Horst KK, Carr BM, Parvinian A, McDonald JS. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the presentation of paediatric acute appendicitis: an observational study. Clin Radiol 2022; 77:943-951. [PMID: 36184302 PMCID: PMC9458697 DOI: 10.1016/j.crad.2022.08.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 12/05/2022]
Abstract
Aim To determine whether there were differences in the clinical presentation of patients imaged to evaluate for acute appendicitis in 2020 compared to 2019 with the hope that this information might better identify patients who should undergo imaging work-up and those who should not. Materials and methods This retrospective observational study included patients <18 years who were evaluated for appendicitis between 1 March and 31 May 2019 and 2020. A total of 465 patients were stratified by final diagnosis (appendicitis versus not appendicitis) and compared based on presenting symptoms, physical examination findings, vital signs, and laboratory test results. Results Symptoms and physical examination findings that were significant in the positive cohort in both years included right lower quadrant pain, pain with movement, migration of pain, right lower quadrant tenderness, and peritoneal findings. Reporting upper respiratory symptoms was an independent predictor of negative results among all patients and in 2019. Both negative cohorts were more likely to have negative physical examinations. Anorexia and nausea/vomiting were more likely among positive cases in 2019 whereas diarrhoea was more likely among positive cases in 2020. Conclusions The COVID-19 pandemic did not significantly change the presenting features of acute appendicitis. The results of the present study emphasise the importance of the physical examination. The ambiguity of symptoms that mimic gastroenteritis justifies imaging in these patients.
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Affiliation(s)
- K K Horst
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA.
| | - B M Carr
- Department of Emergency Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
| | - A Parvinian
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
| | - J S McDonald
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
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Poget M, Chautems R, Kohler R, Diana M, Saadi A. Impact of the COVID-19 pandemic on the severity and management of acute appendicitis. Front Surg 2022; 9:981885. [PMID: 36117810 PMCID: PMC9474729 DOI: 10.3389/fsurg.2022.981885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background The literature seems to indicate that the number of appendectomies dropped at the beginning of the coronavirus disease in 2019 (COVID-19 pandemic), while the number of complicated appendicitis increased due to late presentation. In addition, a longer delay before surgical treatment resulted in a higher morbidity. This study aims to compare the number of appendectomies, the severity, and the management of acute appendicitis during the first two pandemic peaks of COVID-19 with those observed during the same seasonal periods in the previous 2 years in a regional hospital in Switzerland. Methods We retrospectively reviewed and compared the number of appendectomies, rate of complicated appendicitis, delay to consultation and to surgery, distribution of appendectomies over a 24-h schedule, postoperative outcomes, and rates of overall complications in 177 patients, that is, 66 during the COVID-19 pandemic and 111 before the pandemic. Results No statistical difference was found in the number of appendectomies, duration of symptoms before consultation, median time to surgery, number of appendectomies performed outside the usual scheduled time for non-urgent surgery, length of postoperative stay, or the rates of overall complications. However, there was a trend in the rate of complicated appendicitis (p = .05). Conclusion In spite of a high incidence rate of COVID-19 in our canton, the impact of COVID-19 on our population did not follow the pattern observed elsewhere. The reasons for this might be that people would still present to the emergency department due to less strict social distancing measures. Great availability of emergency operating room may also account for the unchanged delay preceding surgical treatment and complication rates.
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Affiliation(s)
- Marion Poget
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Roland Chautems
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Rémy Kohler
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
- Surgery Department, Geneva University Hospitals, Geneva, Switzerland
| | - Michele Diana
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
- Surgery Department, University Hospital of Strasbourg, Strasbourg, France
| | - Alend Saadi
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
- Obesity and Metabolic Diseases Center, Neuchâtel Hospital, Neuchâtel, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Correspondence: Alend Saadi
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Wang F, Wu JM, Lin YC, Ho TW, Lin HL, Yu HY, Lai IR. Coronavirus Disease Pandemic Effect on Medical-Seeking Behaviors Even in One Resource-Competent Community: A Case Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710822. [PMID: 36078536 PMCID: PMC9518467 DOI: 10.3390/ijerph191710822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 05/21/2023]
Abstract
(1) Background: The coronavirus disease 2019 (COVID-19) pandemic had overwhelming impacts on medical services. During its initial surge, Taiwan was unique in maintaining its medical services without imposing travel restrictions, which provided an ideal environment in which to test if the fear of becoming infected with COVID-19 interfered with health-seeking behavior (HSB). We tested this hypothesis among adults with acute complicated appendicitis (ACA). (2) Methods: Adults with acute appendicitis were enrolled between 1 January and 30 June 2020 (COVID-19 period). The first two quarters of the preceding 3 years were defined as a historical control group. Outcome measures included the rate of ACA and the number of hospital stays. (3) Results: The COVID-19 era included 145 patients with acute appendicitis. Compared to the historical control (320 patients), the COVID-19 era was significantly associated with a higher length of symptom duration until presentation to the emergency room within >48 h (17.2% vs. 9.1%, p = 0.011), a higher incidence of ACA (29.7% vs. 19.4%, p = 0.014), and a longer length of hospital stays (5.0 days vs. 4.0 days, p = 0.043). The adjusted models showed that the COVID-19 period had a significant relationship with a higher rate of ACA (odds ratio (OR) = 1.87; 95% confidence interval (CI): 1.23-2.52; p = 0.008) and longer length of hospital stays (OR= 2.10; 95% CI: 0.92 to 3.31; p < 0.001). (4) Conclusions: The fear of COVID-19 may prohibit patients from seeking medical help, worsening their clinical outcomes. The surgical community should take action to provide scientific information to relive mental stress.
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Affiliation(s)
- Fang Wang
- Department of Nursing, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan
| | - Yi-Chieh Lin
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Te-Wei Ho
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Hui-Lin Lin
- Department of Nursing, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hsi-Yu Yu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Correspondence: (H.-Y.Y.); (I.-R.L.); Tel.: +886-2-23123456 (ext. 65107) (I.-R.L.)
| | - I-Rue Lai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Correspondence: (H.-Y.Y.); (I.-R.L.); Tel.: +886-2-23123456 (ext. 65107) (I.-R.L.)
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Kariya A, Krutsri C, Singhatas P, Sumritpradit P, Thampongsa T, Lertsitthichai P, Phoprom N. Incidence of complicated appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022; 45:100512. [PMID: 35845315 PMCID: PMC9273516 DOI: 10.1016/j.ijso.2022.100512] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Abduljubbar Kariya
- Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chonlada Krutsri
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsasit Singhatas
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Preeda Sumritpradit
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tharin Thampongsa
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Napaphat Phoprom
- Surgical Research Unit, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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de Almeida Leite RM, Seo DJ, Gomez-Eslava B, Hossain S, Lesegretain A, de Souza AV, Bay CP, Zilberstein B, Marchi E, Machado RB, Barchi LC, Ricciardi R. Nonoperative vs Operative Management of Uncomplicated Acute Appendicitis: A Systematic Review and Meta-Analysis. JAMA Surg 2022; 157:828-834. [PMID: 35895073 PMCID: PMC9330355 DOI: 10.1001/jamasurg.2022.2937] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Appendectomy remains the standard of care for uncomplicated acute appendicitis despite several randomized clinical trials pointing to the safety and efficacy of nonoperative management of this disease. A meta-analysis of randomized clinical trials may contribute to the body of evidence and help surgeons select which patients may benefit from surgical and nonsurgical treatment. Objective To assess the efficacy and safety of nonoperative management vs appendectomy for acute uncomplicated appendicitis. Data Sources A systematic review was conducted using indexed sources (Embase and PubMed) to search for published randomized clinical trials in English comparing nonoperative management with appendectomy in adult patients presenting with uncomplicated acute appendicitis. To increase sensitivity, no limits were set for outcomes reported, sex, or year of publication. All nonrandomized or quasi-randomized trials were excluded, and validated primers were used. Study Selection Among 1504 studies imported for screening, 805 were duplicates, and 595 were excluded for irrelevancy. A further 96 were excluded after full-text review, mainly owing to wrong study design or inclusion of pediatric populations. Eight studies met the inclusion criteria and were selected for the meta-analysis. Data Extraction and Synthesis Meta-extraction was conducted with independent extraction by multiple reviewers using the Covidence platform for systematic reviews and in accordance with PRISMA guidelines. Data were pooled by a random-effects model. Main Outcomes and Measures Treatment success and major adverse effects at 30 days' follow-up. Results The main outcome (treatment success proportion at 30 days of follow-up) was not significantly different in the operative and nonoperative management cohorts (risk ratio [RR], 0.85; 95% CI, 0.66-1.11). Likewise, the percentage of major adverse effects was similar in both cohorts (RR, 0.72; 95% CI, 0.29-1.79). However, in the nonoperative management group, length of stay was significantly longer (RR, 1.48; 95% CI, 1.26-1.70), and a median cumulative incidence of 18% of recurrent appendicitis was observed. Conclusions and Relevance These results point to the general safety and efficacy of nonoperative management of uncomplicated acute appendicitis. However, this strategy may be associated with an increase in duration of hospital stay and a higher rate of recurrent appendicitis. This meta-analysis may help inform decision-making in nonoperative management of uncomplicated acute appendicitis.
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Affiliation(s)
- Rodrigo Moises de Almeida Leite
- Colon and Rectal Surgery Department, Massachusetts General Hospital, Boston.,Gastrointestinal Surgery Department, Gastromed Institute, Sao Paulo, Brazil
| | - Dong Joo Seo
- Colon and Rectal Surgery Department, Massachusetts General Hospital, Boston
| | | | - Sigma Hossain
- Colon and Rectal Surgery Department, Massachusetts General Hospital, Boston
| | - Arnaud Lesegretain
- Colon and Rectal Surgery Department, Massachusetts General Hospital, Boston
| | | | - Camden Phillip Bay
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bruno Zilberstein
- Gastrointestinal Surgery Department, Gastromed Institute, Sao Paulo, Brazil.,Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Evaldo Marchi
- Department of General Surgery, Faculdade de Medicina de Jundiaí, Jundiaí, Brazil
| | | | - Leandro Cardoso Barchi
- Gastrointestinal Surgery Department, Gastromed Institute, Sao Paulo, Brazil.,Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rocco Ricciardi
- Section of Colon & Rectal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
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Wang WD, Lin JQ, Zheng GW, Fang ZP, Yan YX. Analysis of appendicitis management during COVID-19 pandemic: A study of Chinese adult cohorts. Front Surg 2022; 9:961258. [PMID: 36468079 PMCID: PMC9709813 DOI: 10.3389/fsurg.2022.961258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/11/2022] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Healthcare seeking behavior has been widely impacted due to the restricted movements of individuals during the Coronavirus disease-19 (COVID-19) pandemic. This study aims to perform risk stratification in patients requiring timely intervention during the recovery periods. METHODS Operation notes of acute appendicitis (AA) patients within a hospital were analyzed during three six-month periods (23 January-23 July in 2019, 2020, and 2021, respectively). Patient data were collected retrospectively including demographics, pre-emergency status, perioperative information, postoperative outcomes, and follow-up results. RESULTS 321 patients were included in this study, with 111, 86, and 124 patients in 2019, 2020, and 2021 groups, respectively. The median age of patients decreased by 4 years in 2020 as compared to that in 2019. The proportion of pre-hospitalization symptoms duration of more than 48 h in the 2020 group was higher (36.05% in 2020 vs. 22.52% in 2019). Length of hospital stay (LOS) in 2020 was shorter than it was during the same period in 2019 (4.77 vs. 5.64) and LOS in 2021 was shorter than in 2019 (4.13 vs. 5.64). Compared to the lockdown period, the proportion of patients with recurrent AA was higher in the post-lockdown period (15.1% vs. 27.4%). The median age was 34 years (vaccinated) vs. 37 years (unvaccinated). Logistic regression suggests that elevated C-reactive protein (CRP) (OR = 1.018, CI = 1.010-1.028), white cell count (WBC) (OR = 1.207, CI = 1.079-1.350), female (OR = 2.958, CI = 1.286-6.802), recurrent (OR = 3.865, CI = 1.149-12.997), and fecalith (OR = 2.308, CI = 1.007-5.289) were associated with complicated appendicitis (CA). CONCLUSION The lockdown measures during the COVID-19 epidemic are shown to be correlated with a reduction in the proportion of AA patients who underwent surgery, particularly in older adults. Risk factors for CA include elevated CRP, WBC, female, recurrent, and fecalith.
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DAL MB, UĞUR M, DUYMUŞ ME, TEMİZ M. Management of oncological and emergency surgery cases during COVID-19 pandemic. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1141011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Acil cerrahi vakalara Genel Cerrahide önemli bir yer tutmaktadır. COVID-19 salgını döneminde, hastaların salgından etkilenme korkusu ve davranış şekillerinin karmaşıklığı bu hastalıkların teşhis ve tedavisini zorlaştırmaktadır.
Yöntem: Üçüncü basamak olan merkezimizde, COVID pandemisi sırasında akut apandisit, kolesistit ve kolorektal kanser tanısı ile cerrahi geçiren hastaların bilgisayarlı veri tabanı retrospektif olarak pandemi öncesi ve pandemi dönemi şeklinde gözden geçirildi.
Bulgular: Çalışma süresi boyunca 1100 hasta apandisit, 500 hasta kolesistit, 120 hasta onkolojik hastalıklar nedeni ile ameliyat edildi. Ortalama yaş her iki dönem için benzerdi, pandemi öncesi dönemde 34.06 ± 16.7 pandemi döneminde 36,72 ± 15,31 yaş ortalaması mevcuttu. Semptom başlaması ile hastaların hastaneye başvuru süreleri her iki döneme benzerdir (34,55 ± 31,51 ile 34,35 ± 37,94 sa, P = 0,968). Laboratuvar testler arasında anlamlı bir farklılık göstermemiştir. WBC değerleri pandemi öncesi dönemde 12.73 ± 4.3 × 103 idi pandemi sonrası dönemde 13.62 ± 4.62×103 (P = 0.1308) idi. Pandemi öncesi ve pandemi döneminde tüm hastalar en az 1 görüntüleme yöntemi kullanılmıştır.
Sonuç: COVID-19 pandemisinin ilk aşamasında, komplike acil cerrahi gereksinimi oranında önemli bir artış vardı. Hastalar bundan kaçınmaları için semptomların başlaması ile acil polikliniklere başvurmaları şiddetle teşvik edilmelidir.
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Affiliation(s)
- M. Burak DAL
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, TAYFUR ATA SÖKMEN TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
| | - Mustafa UĞUR
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, TAYFUR ATA SÖKMEN TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
| | - Mehmet Esat DUYMUŞ
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, TAYFUR ATA SÖKMEN TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
| | - Muhyittin TEMİZ
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, TAYFUR ATA SÖKMEN TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
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van Amstel P, El Ghazzaoui A, Hall NJ, Wester T, Morini F, van der Lee JH, Singer G, Pierro A, Zani A, Gorter RR. Paediatric appendicitis: international study of management in the COVID-19 pandemic. Br J Surg 2022; 109:1044-1048. [PMID: 36240511 PMCID: PMC9384519 DOI: 10.1093/bjs/znac239] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/21/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Paul van Amstel
- Correspondence to: Paul van Amstel, Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (e-mail: )
| | - Ali El Ghazzaoui
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Tomas Wester
- Department of Paediatric Surgery, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Francesco Morini
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Johanna H van der Lee
- Pediatric Clinical Research Office, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, the Netherlands
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Agostino Pierro
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Augusto Zani
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ramon R Gorter
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Özkan MÇ, Saraç Ö, Deniz Kesimer M, Akdeniz Doğan Z, Nihal Durmus Kocaaslan F, Sacak B. Impact of COVID-19 pandemic on hand injuries. ULUS TRAVMA ACIL CER 2022; 28:911-919. [PMID: 35775678 PMCID: PMC10493839 DOI: 10.14744/tjtes.2021.75100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of the study was to evaluate etiologies of hand injuries in emergency department (ED), to compare the etiologies of hand injuries at the time of this study with the previous year, to assess whether novel coronavirus-2019 (COVID-19) pandemic affected the treatment decisions, and to investigate the COVID-19 infection rate within the first 14 days after admission. METHODS A total of 229 patients admitted to ED with hand injury between March 15 and April 30, 2020, were included in the study. The control group consisted of 439 ED admissions with hand injury in the previous year (March 15-April 30, 2019). Data including age, sex, cause of trauma, treatment, and COVID-19 infection status within 14 days after ED admission were compared between groups. RESULTS The mean age was 32.30±15.63 years in the study group and 30.85±18.54 years in the control group. The number of patients consulted to the surgery department decreased by 52.6% and the number of patients admitted to ED with hand injuries de-creased by 47.6% during the pandemic, compared to the previous year (p=0.0001). The incidence of home accidents increased and the glass cuts and penetrating/perforating injuries were the most common causes during the pandemic most of which occurred at home. CONCLUSION The COVID-19 pandemic-mandated social restrictions led to a significant decrease in the number of ED admissions with hand injuries and the type of injuries. The incidence of home accidents increased with more time spent indoors. This study may be a useful guide for ED admissions of hand injury cases and management planning in the current and future pandemics.
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Affiliation(s)
- Melekber Çavuş Özkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul-Türkiye
| | - Ömer Saraç
- Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul-Türkiye
| | - Mehmet Deniz Kesimer
- Department of Orthopedics and Traumatology, Marmara University Faculty of Medicine, İstanbul-Türkiye
| | - Zeynep Akdeniz Doğan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul-Türkiye
| | - Fatma Nihal Durmus Kocaaslan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul-Türkiye
| | - Bulent Sacak
- Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul-Türkiye
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A Comparison of Pediatric Appendicitis During the COVID-19 Pandemic and the Same Period Previous Year. HEALTH SCOPE 2022. [DOI: 10.5812/jhealthscope-126935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Although appendicitis is the most common emergency abdominal surgical pathology in the pediatric age group, there are a limited number of publications in the literature on how appendicitis has affected patients during the COVID-19 pandemic. Objectives: This study examined the effects of fear of being infected with COVID-19 and isolation measures on complications and morbidity in pediatric appendicitis cases. Methods: This study was performed in the Department of Pediatric Surgery, Faculty of Medicine, Health Sciences University, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey. Patients aged 18 years and younger who were operated on for appendicitis between 11 March 2019 and 11 May 2019 were classified as group 1, and patients aged 18 years and younger who were operated on for appendicitis between 11 March 2020 and 11 May 2020 (during the pandemic) were classified as group 2. Both groups were compared in terms of age, gender, symptoms, duration of symptoms, surgical method, duration of operation, length of hospital stay, and postoperative complications. Results: There were 85 patients in group 1 and 49 in group 2. The mean age was 11.5 ± 3.5 years in group 1 and 12.2 ± 3.0 years in group 2. While the mean hospital admission time for group 1 was 52.2 ± 38.5 hours, it was 50.2 ± 40.0 hours for group 2. The complicated appendicitis rates were 37% and 25% in group 1 and group 2, respectively. In group 1, 94.1% of the operations were completed laparoscopically, whereas, in group 2, this rate was 88.6%. The mean operation time was 64.0 ± 24.4 minutes in group 1 and 69.0 ± 33.0 minutes in group 2. The mean length of hospital stay was 2.9 ± 2.0 days in group 1 and 3.1 ± 3.40 days in group 2. The complication rate was 8.2% in group 1 and 11.4% in group 2. Conclusions: Despite the isolation measures and the risk of virus transmission, the psychosocial effects of the pandemic did not prevent real emergency cases with appendicitis from visiting hospitals.
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Ocak S, Bük ÖF, Uyanık MS, Çiftci AB. COVID-19 outbreak and acute appendicitis: Does the lockdown has a influence on appendectomies?-A single center retrospective cohort study. Turk J Surg 2022; 38:175-179. [PMID: 36483169 PMCID: PMC9714647 DOI: 10.47717/turkjsurg.2022.5440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Healthcare systems have been negatively affected from COVID-19 pandemic worldwide. Elective surgical procedures were postponed and conservative treatment options were considered even in urgent conditions. This study aimed to explore the influence of the COVID-19 pandemic on urgent appendectomy in a pandemic hospital. MATERIAL AND METHODS Patients on whom appendectomy was performed between March 2020- June 2020 were included into the study (pandemic group). For comparison, control group patients were selected in the same period of 2019 (control group). Patients' demographics, laboratory and radiological findings, length of hospital stay, complications and histopathological findings of the groups were compared. RESULTS Forty-six patients were included in pandemic group and and one hundred-one in the control group. Patient characteristics were similar in both groups. There were no significant differences in type of surgery, complications, laboratory and histopathological findings. In the control group, length of hospital stay was longer when compared with the pandemic group. CONCLUSION Although the number of appendectomies performed decreased significantly during the COVID-19 pandemic, perioperative parameters were similar in both groups.
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Affiliation(s)
- Sönmez Ocak
- Clinic of General Surgery, Samsun Research and Training Hospital, Samsun, Türkiye
| | - Ömer Faruk Bük
- Clinic of General Surgery, Samsun Research and Training Hospital, Samsun, Türkiye
| | - Mustafa Safa Uyanık
- Clinic of General Surgery, Samsun Research and Training Hospital, Samsun, Türkiye
| | - Ahmet Burak Çiftci
- Clinic of General Surgery, Samsun Research and Training Hospital, Samsun, Türkiye
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Petrauskas V, Poskus E, Luksaite – Lukste R, Kryzauskas M, Petrulionis M, Strupas K, Poskus T. Suspected and Confirmed Acute Appendicitis During the COVID-19 Pandemic: First and Second Quarantines—a Prospective Study. Front Surg 2022; 9:896206. [PMID: 35800113 PMCID: PMC9253423 DOI: 10.3389/fsurg.2022.896206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/26/2022] [Indexed: 01/08/2023] Open
Abstract
PurposeCOVID-19 posed an unprecedented modern global healthcare crisis affecting both elective and urgent surgeries. The aim of this study is to evaluate the difference in the presentation of acute appendicitis (AA) before and during the COVID-19 era, the first and second quarantines.MethodsWe performed a prospective study from December 2018 to May 2021. Two cohorts were analysed, one with patients who presented to the emergency department (ED) with suspected AA and the second with confirmed AA. Both cohorts were divided into four groups: before COVID-19, during the first quarantine, between the first and second quarantine, and during the second quarantine. Data such as demographics, the time to first contact with the healthcare provider and time to operation, laboratory tests, clinical stage of AA, length of stay, and COVID-19 status were collected. A total of 469 patients were enrolled.ResultsA total of 209 patients were male (45%) and 260 were female (55%), with the median age being 33 years (24–45). In the first cohort of suspected AA, there was no difference in sex; however, more older patients presented to the ED during the first quarantine (41 years) compared with other groups (28.5, 36, and 32.5 years), p < 0.000. Before the pandemic, there was a shorter duration of symptoms to first contact with the healthcare provider (13 h) compared with other groups, p = 0.001. In the second cohort of confirmed AA, there was a shorter period of time to operation from first symptoms before the pandemic (22 h) compared with other groups (30, 35, 30.5 h), p < 0.000. There were more complicated gangrenous, perforated appendicitis or periappendicular abscess in Group 2 and 3 (26, 22 and 10%, and 26, 22 and 2%, respectively) compared with Group 1 (20, 4 and 3%) and Group 4 (22, 12, and 2%), p = 0.009. Hospital stay was longer during the first quarantine (3 days) compared with other groups (2 days), p = 0.009. Six patients were COVID-19 positive: one from Group 3 and five from Group 4 (p > 0.05).ConclusionsOur study suggests that during the first quarantine of the COVID-19 pandemic, there was delayed presentation to the ED with suspected AA and there was a greater proportion of complicated appendicitis and longer hospitalization in confirmed cases as well.
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Affiliation(s)
- Vidas Petrauskas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Correspondence: Vidas Petrauskas
| | - Eligijus Poskus
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Raminta Luksaite – Lukste
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Kryzauskas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Petrulionis
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Mogharab V, Ostovar M, Ruszkowski J, Hussain SZM, Shrestha R, Yaqoob U, Aryanpoor P, Nikkhoo AM, Heidari P, Jahromi AR, Rayatdoost E, Ali A, Javdani F, Farzaneh R, Ghanaatpisheh A, Habibzadeh SR, Foroughian M, Ahmadi SR, Akhavan R, Abbasi B, Shahi B, Hakemi A, Bolvardi E, Bagherian F, Motamed M, Boroujeni ST, Jamalnia S, Mangouri A, Paydar M, Mehrasa N, Shirali D, Sanmarchi F, Saeed A, Jafari NA, Babou A, Kalani N, Hatami N. Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses. Global Health 2022; 18:58. [PMID: 35676714 PMCID: PMC9175527 DOI: 10.1186/s12992-022-00836-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023] Open
Abstract
Background Apart from infecting a large number of people around the world and causing the death of many people, the COVID-19 pandemic seems to have changed the healthcare processes of other diseases by changing the allocation of health resources and changing people’s access or intention to healthcare systems. Objective To compare the incidence of endpoints marking delayed healthcare seeking in medical emergencies, before and during the pandemic. Methods Based on a PICO model, medical emergency conditions that need timely intervention was selected to be evaluated as separate panels. In a systematic literature review, PubMed was quarried for each panel for studies comparing the incidence of various medical emergencies before and during the COVID-19 pandemic. Markers of failure/disruption of treatment due to delayed referral were included in the meta-analysis for each panel. Result There was a statistically significant increased pooled median time of symptom onset to admission of the acute coronary syndrome (ACS) patients; an increased rate of vasospasm of aneurismal subarachnoid hemorrhage; and perforation rate in acute appendicitis; diabetic ketoacidosis presentation rate among Type 1 Diabetes Mellitus patients; and rate of orchiectomy among testicular torsion patients in comparison of pre-COVID-19 with COVID-19 cohorts; while there were no significant changes in the event rate of ruptured ectopic pregnancy and median time of symptom onset to admission in the cerebrovascular accident (CVA) patients. Conclusions COVID-19 has largely disrupted the referral of patients for emergency medical care and patient-related delayed care should be addressed as a major health threat. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00836-2.
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Affiliation(s)
- Vahid Mogharab
- Department of Pediatrics, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mahshid Ostovar
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Jakub Ruszkowski
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.,Department of Pathophysiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Rajeev Shrestha
- Palliative Care and Chronic Disease Unit, Green Pasteur Hospital, Pokhara, Nepal
| | - Uzair Yaqoob
- Postgraduate trainee, Surgical Department, Hamdard University Hospital Karachi, Karachi, Pakistan
| | - Poorya Aryanpoor
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Amir Mohammad Nikkhoo
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Parasta Heidari
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Athar Rasekh Jahromi
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Esmaeil Rayatdoost
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Anwar Ali
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Farshid Javdani
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Roohie Farzaneh
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aref Ghanaatpisheh
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Seyed Reza Habibzadeh
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Foroughian
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sayyed Reza Ahmadi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Akhavan
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Abbasi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
| | - Behzad Shahi
- Department of Emergency Medicine, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Arman Hakemi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Bolvardi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Bagherian
- Department of Emergency Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mahsa Motamed
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sheida Jamalnia
- Medical Journalism Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Mangouri
- Fellowship of Vascular Surgery and Endovascular Therapy, Division of Vascular Surgery and Endovascular Therapy, Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Paydar
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Neda Mehrasa
- Shiraz Azad University, Dental Branch, Shiraz, Iran
| | | | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Ayesha Saeed
- Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Narges Azari Jafari
- Neuroscience Research Department Center, Kashan University of Medical Science, Kashan, Iran
| | - Ali Babou
- Pharmaceutical Sciences Department, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Navid Kalani
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Naser Hatami
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
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Kanamori D, Kurobe M, Sugihara T, Harada A, Kaji S, Uchida G, Baba Y, Ohashi S, Ashizuka S, Ohki T. Increase in pediatric complicated appendicitis during the COVID-19 pandemic: a multi-center retrospective study. Surg Today 2022; 52:1741-1745. [PMID: 35672523 PMCID: PMC9172983 DOI: 10.1007/s00595-022-02529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/30/2022] [Indexed: 11/06/2022]
Abstract
Purpose An increase in the incidence of pediatric complicated appendicitis (CA) during the COVID-19 pandemic has been reported in many countries. We investigated how the pandemic has affected Japan. Methods We retrospectively reviewed children of ≤ 15 years old treated for acute appendicitis across 5 medical centers during the pandemic period (January to October in 2020), with the pre-pandemic period (January to October in 2017 to 2019) evaluated as a historical control. The incidence of CA and disease characteristics were then compared between the periods. Results The total number of patients was 55 in 2020 and 192 in 2017–2019. In all centers, the incidence of acute pediatric CA in the pandemic period significantly increased compared to the pre-pandemic period (18.2% vs. 32.7%, p = 0.02). On limiting our evaluation to the 3 institutions with reductions in patient numbers, the incidence of CA increased (16.3% vs. 37.9%, p = 0.01), and the duration of pre-operative symptoms was prolonged (1.3% vs. 1.7 days, p = 0.03). There were no significant differences in the age, sex, white blood cell count, C-reactive protein, or body temperature. No cases were diagnosed with SARS-CoV-2. Conclusions The incidence of acute pediatric CA increased during the pandemic period. This may be related to an extended duration of symptoms due to individuals fearing contracting COVID-19 while visiting a hospital.
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Affiliation(s)
- Daisuke Kanamori
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Masashi Kurobe
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tetsuro Sugihara
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Atsushi Harada
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Sayuri Kaji
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Goki Uchida
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuji Baba
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shinsuke Ohashi
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shuichi Ashizuka
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takao Ohki
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Grossi U, Gallo G, Ortenzi M, Piccino M, Salimian N, Guerrieri M, Sammarco G, Felice C, Santoro GA, Di Saverio S, Di Tanna GL, Zanus G. Changes in hospital admissions and complications of acute appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis. HEALTH SCIENCES REVIEW (OXFORD, ENGLAND) 2022; 3:100021. [PMID: 35287332 PMCID: PMC8906891 DOI: 10.1016/j.hsr.2022.100021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/29/2022]
Abstract
Background Acute appendicitis (AA) is one of the most common emergencies in general surgery worldwide. During the pandemic, a significant decrease in the number of accesses to the emergency department for AA has been recorded in different countries. A systematic review of the current literature sought to determine the impact of Coronavirus Disease 2019 (COVID-19) on hospital admissions and complications of AA. Method A systematic search was undertaken to identify repeated cross-sectional studies reporting the management of AA during the COVID-19 pandemic (index period) as compared to the previous year, or at the turn of lockdown (reference period). Data were abstracted on article (country of origin) and patients characteristics (adults, children [i.e. non adults, <18-year-old]), or mixed population) within the two given timeframes, including demographics, number of admissions for AA, number of appendectomies, and complicated appendectomies. Results Of 201 full-text articles assessed for eligibility, 54 studies from 22 world countries were included. In total, 27 (50%) were conducted on adults, 12 (22%) on children, and 15 (28%) on a mixed patients population. The overall rate ratio of admissions for AA between the two periods was 0.94 (95%CI, 0.75-1.17), with significant differences between studies on adults (0.90 [0.74-1.09]), mixed population (0.50 [0.27-0.90]), and children (1.50 [1.01-2.22]). The overall risk ratio of complicated AA was 1.65 (1.32-2.07), ranging from 1.32 in studies on children, to 2.45 in mixed population. Conclusion The pandemic has altered the rate of admissions for AA and appendectomy, with parallel increased incidence of complicated cases in all age groups.
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Affiliation(s)
- Ugo Grossi
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy,Corresponding author at: National Bowel Research Centre, Queen Mary University of London, 2 Newark Street, London E1 2AT, United Kingdom
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Marco Piccino
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Nick Salimian
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Giuseppe Sammarco
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Carla Felice
- I Medicine Unit, Treviso Regional Hospital, DIMED, University of Padua, Italy
| | | | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Giacomo Zanus
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
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Turhan N, Arıcan ÇD. The effects of COVID-19 pandemic on patients with acute appendicitis. ULUS TRAVMA ACIL CER 2022; 28:756-761. [PMID: 35652875 PMCID: PMC10443006 DOI: 10.14744/tjtes.2021.53929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The effects of the COVID-19 infection on the world's health system began to be reported in a short time, with the spread of the infection all over the world and it gained a global acceptance as a pandemic. It was predicted that patients who require urgent surgical procedures may not be able to access appropriate treatment during this period and may suffer from this process. In this process, we planned to report the effects of the pandemic process to this patient group by evaluating patients with acute appendicitis, which is the most common cause of acute abdomen among general surgery emergencies. METHODS In our study, we compared the patients who applied to the Training and Research Hospital we collaborated, whose clinics were compatible with acute appendicitis, between March 11, 2020, and May 21, 2020, with those applied within the same time period with the year before. We evaluated clinical and pathological findings of the patients and the treatment applied. RESULTS In this study, there were 103 patients diagnosed with acute appendicitis before pandemic and 61 in pandemic period. We found that during the pandemic period, patients with acute appendicitis were admitted to the hospital less often, and in a later period, and more complicated clinical pictures were determined. Complicated appendicitis patients were higher in pandemic period compared with previous year (33.96% vs. 8.00% of patients, respectively; p<0.05). CONCLUSION We emphasized that diseases that need to be treated urgently should not be left behind during the pandemic. Furthermore, we shared our clinical practice to ensure early discharge of patients with acute appendicitis during the pandemic process.
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Affiliation(s)
- Nihan Turhan
- Department of General Surgery, Martyr Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, İstanbul-Turkey
| | - Çiğdem Dicle Arıcan
- Department of Medical Pathology, Martyr Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, İstanbul-Turkey
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Tamirian R, Klein M, Chui P, Park J, Frangos S, Shah P, Malino CM. Acute Appendicitis During The COVID-19 Pandemic: A Multicenter, Retrospective Analysis From The US Epicenter. Am Surg 2022:31348221103649. [PMID: 35599614 PMCID: PMC9124948 DOI: 10.1177/00031348221103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Acute appendicitis (AA) is the most common surgical emergency, with a relatively stable yearly incidence. During the first wave of the COVID-19 pandemic, as New York City (NYC) emerged as the US epicenter, hospitals saw a marked reduction in patients presenting with non-COVID-related diseases. The objective of this study was to characterize the effects of the pandemic on the incidence, presentation, and management of AA. Methods A retrospective analysis of patients with AA who presented to two academic medical centers during the NYC COVID peak (March 22nd-May 31st, 2020) was performed. This group was compared to a control cohort presenting during the same period in 2019. Primary outcomes included the incidence of AA, complicated disease, and management. Secondary outcomes included duration of symptoms, hospital length of stay, and complication rates. Statistical analyses were performed using Mann-Whitney U, Chi-square, and Fisher’s exact tests. Results A 49.1% reduction in the incidence of AA was seen between 2019 (n = 114) and 2020 (n = 58). Median duration of symptoms doubled from 1 day in 2019 to 2 days in 2020 (P < .02). Proportionally, the incidence of complicated appendicitis rose from 19.3% to 41.4% (P < .005). 32.4% of patients with uncomplicated AA underwent non-operative management in 2020, compared to 12% in 2019 (P < .02). Hospital length of stay and complication rates were similar between years. Discussion Significantly fewer AA patients presented during the initial phase of the pandemic. Patients presented later, which may have contributed to a higher proportion of complicated disease. Surgeons were also more likely to treat uncomplicated AA nonoperatively than they were prior. Further research is needed to understand the long-term consequences of these changes.
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Affiliation(s)
- Richard Tamirian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Richard Tamirian, Department of Surgery, NYU Grossman School of Medicine, 334 E. 26th Street New York, NY 10010, USA.
| | - Michael Klein
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Department of Surgery, New York City Health + Hospitals/Bellevue, New York, NY, USA
| | - Patricia Chui
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Department of Surgery, New York City Health + Hospitals/Bellevue, New York, NY, USA
| | - Julia Park
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Department of Surgery, New York City Health + Hospitals/Bellevue, New York, NY, USA
| | - Spiros Frangos
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Department of Surgery, New York City Health + Hospitals/Bellevue, New York, NY, USA
| | - Paresh Shah
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Cris M.K. Malino
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
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Routine surgeries during the COVID-19 pandemic: A French nationwide cohort study. Ann Med Surg (Lond) 2022; 77:103721. [PMID: 35531430 PMCID: PMC9065655 DOI: 10.1016/j.amsu.2022.103721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background The COVID-19 pandemic inevitably had consequences on routine surgical procedures. The objective was to quantify changes to five surgical procedures during the COVID-19 pandemic namely cataract surgery, hip and knee arthoplasties, coronary revascularization by angioplasty and definitive cardiac stimulation. Materials and method All hospitalizations with at least one act of each surgery between January 1, 2019, and June 30, 2021, were included from the database of all French residents’ health-related expenses. Percentage changes between observed and expected numbers of hospital stays were calculated for each surgery in 2020 and the first half of 2021 with 95% Confidence Intervals. Expected numbers were calculated from the number in 2019 by applying an average annual change between 2015 and 2019. The type of intervention (primary operation or reoperation/revision) and/or the emergency status were also considered. Results A total of 2,153,857 hospitalizations for cataract surgery (0.6% revision), 398,213 for hip arthroplasty (10.9% revision and 26.9% in emergency), 276,607 for knee arthroplasty (8.2% revision), 471,318 for coronary angioplasty (48.7% in emergency) and 178,441 for cardiac stimulation (27.6% revision) were included. Activity was lower than expected in 2020 (cataract surgery: −21.9% [−22.5;−21.4]; hip arthroplasty: −13.4% [−14.8;−12.0]; knee arthroplasty: −24.6% [−26.1;−23.0]; coronary angioplasty: −11.2% [−12.7;−9.7]) without any catch–up in the first half of 2021 (cataract surgery: −5.0% [−5.8;−4.3]; hip arthroplasty: −9.9% [−11.6;−8.2]; knee arthroplasty: −22.0% [−24.0;−20.1]; coronary angioplasty: −12,1% [−13.9;−10.4]). Revisions and non-elective interventions also decreased but to a lesser magnitude. Cardiac stimulation activity was almost in line with expectations (−2.6% [−4.9; −0.3]/+0.6 [−2.2; +3.4]). Conclusion This study shows that there was a marked decrease in four routine surgeries compared to expectations through to at least the first half of 2021, despite the gradual national rollout of the vaccine. Hospitalizations for cataract surgery, coronary angioplasty, hip and knee arthroplasties were strongly impacted by the pandemic from 2020 until the first half of 2021, without any catch-up outside the lockdown periods and despite the gradual rollout of the national COVID-19 vaccine campaign in 2021. Definitive cardiac stimulation was the only surgery not really impacted. Optimize surgical patient care in a pandemic setting and identify ways to improve the available capacity of surgical activity.
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Sevinç MM, Karagülle OO, Kaya R, Ertürk C, Doğan S. Evaluation of the appendectomy cases performed under emergency conditions during the COVID-19 pandemic and discussed with the pathology reports. ULUS TRAVMA ACIL CER 2022; 28:703-710. [PMID: 35485461 PMCID: PMC10442994 DOI: 10.14744/tjtes.2022.16287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/03/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study is to examine the cases underwent appendectomy during the COVID-19 pandemic and to discuss the pathology reports of patients. METHODS During the COVID-19 pandemic, the pathological reports of the appendectomy materials of 588 patients over the age of 15 who applied to the emergency department between January 1, 2020, and June 1, 2021, were examined. A total of 565 patients with a diagnosis of acute (AA), subacute (SA), or perforated appendicitis (PA) were included and divided into three groups according to diagnosis. Twenty-three patients were excluded from the study due to other pathologies. The age, gender, duration of pain, ASA score, operational technique, operation time, Clavien-Dindo score, hospitalization time, post-operative complications, pre- and post-operative PCR and thoracic tomography findings in suspected cases of COVID-19, and laboratory and radiological findings of patients were retrospectively analyzed. RESULTS Of 565 patients diagnosed with appendicitis, 464 (82.1%) had AA, 35 (6.2%) SA, and 66 (11.7%) PA. The median age of the PA group was higher than in the AA group (p=0.0139). The incidence of diabetes mellitus in the PA group and of asthma in the SA group were highest among other groups (p=0.004 and 0.0037, respectively). The duration of pain was longer in the SA and PA groups than the AA group (p<0.0001), therefore, the patients applied to hospital later than the acute group. The rate of thorax CT-positive scans was 1.6% in patients suspected for COVID-19 (p=0.066). While laparoscopic surgery was preferred over 70% in all groups, the rate of conventional surgery (21.1%) in the AA group was highest and of transition from laparoscopic to open surgery was highest in the PA group (10.6%) (p<0.0001). Hospitalization duration was longest in the PA group (p<0.0001). CONCLUSION COVID-19 pandemic not only changes all routines of social life but also complicates the treatment and manage-ment of cases with AA symptoms applied to hospital under emergency conditions. Follow-up of the appendectomy specimen is crucial in terms of excluding other pathologies.
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Affiliation(s)
- Mert Mahsuni Sevinç
- Department of General Surgery, University of Health Sciences, Istanbul Training and Research Hospital, İstanbul-Turkey
| | - Onur Olgaç Karagülle
- Department of General Surgery, University of Health Sciences, Istanbul Training and Research Hospital, İstanbul-Turkey
| | - Rozan Kaya
- Department of General Surgery, University of Health Sciences, Istanbul Training and Research Hospital, İstanbul-Turkey
| | - Candeniz Ertürk
- Department of General Surgery, University of Health Sciences, Istanbul Training and Research Hospital, İstanbul-Turkey
| | - Selim Doğan
- Department of General Surgery, University of Health Sciences, Istanbul Training and Research Hospital, İstanbul-Turkey
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Nassiri AM, Pruden RD, Holan CA, Guerra AD, Nganga PW, Wilkinson MH, Lawson KA, Allen CH, Gregg VS, Naiditch JA. Pediatric appendicitis in the time of the COVID-19 pandemic: A retrospective chart review. J Am Coll Emerg Physicians Open 2022; 3:e12722. [PMID: 35462960 PMCID: PMC9019144 DOI: 10.1002/emp2.12722] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Aim Conduct a time trend analysis that describes 2 groups of patients admitted to a large tertiary children's hospital that presented with appendicitis and determine if there was an increase in complicated appendicitis when compared between 2 time periods before and during the early coronavirus disease 2019 (COVID‐19) pandemic of 2020. Methods We conducted a retrospective analysis of all children presenting to a single‐center site with appendicitis between March 23 and August 31, 2020, in the Central Texas region. We compared 507 patients presenting with appendicitis from the non‐COVID‐19 era in 2019 with n = 249 to patients presenting during the COVID time period with n = 258. All patients with appendicitis within those time periods were reviewed with analysis of various characteristics in regard to presentation, diagnosis of uncomplicated versus complicated appendicitis, and management outcomes. Results There were no significant demographic differences or change in the number of appendicitis cases noted between the 2 time periods of comparison. There was no significant difference in rates of complicated appendicitis or presentation time following symptom onset between the 2 eras. There was no significant difference in intraoperative or postoperative complications. There was a statistically significant increase in the use of computed tomography (CT) scans (P‐value = 0.004) with patients 1.81 times more likely to have a CT scan in the pandemic era after adjusting for patient‐level factors. The effect of severe acute respiratory syndrome coronavirus 2 status on outcomes was not part of the data analysis. Conclusion Our study is the largest to date examining appendicitis complications in the era of COVID. In the time of the COVID‐19 pandemic, we found no delay in presentation in children presenting to the emergency department and no increase in complicated appendicitis. We did identify an increase in the use of CT scans for definitive diagnosis of appendicitis noted in the pandemic era. Although COVID‐19 status was not studied, the finding of increased CT use for a definitive diagnosis of appendicitis was a distinctive finding of this study showing a change in practice in pediatric emergency medicine.
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Affiliation(s)
- Arianna M Nassiri
- Department of Pediatric Emergency Medicine Dell Children's Medical Center Austin Texas USA
| | - Roy D Pruden
- Department of Pediatrics Dell Children's Medical Center Austin Texas USA
| | - Cole A Holan
- University of Texas Dell Medical School Austin Texas USA
| | | | - Peris W Nganga
- Department of Pediatrics Dell Children's Medical Center Austin Texas USA
| | - Matthew H Wilkinson
- Department of Pediatric Emergency Medicine Dell Children's Medical Center Austin Texas USA
| | - Karla A Lawson
- Department of Surgery and Perioperative Care Division of Pediatric Surgery Dell Children's Medical Center University of Texas Austin Texas USA
| | - Coburn H Allen
- Department of Pediatric Emergency Medicine Dell Children's Medical Center Austin Texas USA
| | - Victoria S Gregg
- Department of Pediatric Emergency Medicine Dell Children's Medical Center Austin Texas USA
| | - Jessica A Naiditch
- Department of Surgery and Perioperative Care Division of Pediatric Surgery Dell Children's Medical Center University of Texas Austin Texas USA
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Boyev A, Sanjeevi S, Estrada MM, Ko TC, Wray CJ. The Impact of COVID-19 Pandemic upon Non-Elective Admissions and Surgery at a Safety-Net Hospital. J Surg Res 2022; 278:376-385. [PMID: 35691248 PMCID: PMC9005438 DOI: 10.1016/j.jss.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/13/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022]
Abstract
Introduction Materials and Methods Results Conclusions
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Affiliation(s)
- Artem Boyev
- Department of Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
| | - Srinivas Sanjeevi
- Department of Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
| | - Martha M Estrada
- Department of Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
| | - Tien C Ko
- Department of Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
| | - Curtis J Wray
- Department of Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas.
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Kusumo Rahardjo A. Case series: Treatment outcome of late presentation of acute appendicitis. Int J Surg Case Rep 2022; 92:106881. [PMID: 35231734 PMCID: PMC8885464 DOI: 10.1016/j.ijscr.2022.106881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 10/29/2022] Open
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Alakuş Ü, Türker B, Sarıgöz T, Mehmet Meral U. Impact of coronavirus disease on acute appendicitis cases. ULUS TRAVMA ACIL CER 2022; 28:285-289. [PMID: 35485557 PMCID: PMC10493522 DOI: 10.14744/tjtes.2020.38632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/04/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Disease profiles have changed in the COVID-19 pandemic. In this study, we aimed to compare acute appendicitis cases before and during the COVID-19 pandemic. METHODS A total of 130 patients were diagnosed with AA and operated between the days of first COVID-19 case on March 11, 2020, and May 11, 2020, and the same period of the previous year. Data of the patients were extracted from electronic archive of the hospital. Those patients were stratified into two groups; pandemic group and pre-pandemic group. The pandemic group comprised 46 patients and the pre-pandemic group, 84 patients. The two groups were compared in terms of age, gender, duration of symptoms, length of hospital stay, white blood cell count, C-reactive protein levels, and post-operative complications. RESULTS The median days passed from onset of abdominal pain to submission were 6.5 days in the pandemic period. However, it was 3 days in the pre-pandemic group (p<0.001). Other parameters were not statistically different between the groups (p>0.05). CONCLUSION During the COVID-19 pandemic period, delay in hospital submissions has attracted attention. However, delayed treatment did not reflect to the clinic as more severe disease.
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Affiliation(s)
- Ümit Alakuş
- Department of General Surgery, Health Sciences University Gülhane Training and Research Hospital, Ankara-Turkey
| | - Barış Türker
- Department of General Surgery, Batman State Hospital, Batman-Turkey
| | - Talha Sarıgöz
- Department of General Surgery, Kayseri City Hospital, Department of General Surgery, Kayseri-Turkey
| | - Ulvi Mehmet Meral
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir-Turkey
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