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Beckermann J, Linnaus ME, Swartz H, Stewart S, York J, Gassner RR, Kasal CA, Seidel AG, Wachter CJ, Kooda KJ, Rich JR, Sawyer MD. Optimizing antibiotic management for patients with acute appendicitis: A quality improvement study. Surgery 2024; 175:1352-1357. [PMID: 38413304 DOI: 10.1016/j.surg.2024.01.010] [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: 08/14/2023] [Revised: 12/12/2023] [Accepted: 01/11/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND To decrease surgical site infections after appendectomy for acute appendicitis, preoperative broad-spectrum antibiotics are often used in clinical practice. However, this treatment strategy has come under scrutiny because of increasing rates of antibiotic-resistant infections. METHODS The aim of this multisite quality improvement project was to decrease the treatment of uncomplicated acute appendicitis with piperacillin-tazobactam without increasing the rate of surgical site infections. Our quality improvement intervention had 2 distinct components: (1) updating electronic health record orders to encourage preoperative administration of narrow-spectrum antibiotics and (2) educating surgeons and emergency department clinicians about selecting appropriate antibiotic therapy for acute appendicitis. Patient demographics, clinical characteristics, and outcomes were compared 6 months before and after implementation of the quality improvement intervention. RESULTS A total of 352 laparoscopic appendectomies were performed during the 6-month preintervention period, and 369 were performed during the 6-month postintervention period. The preintervention period and postintervention period groups had similar baseline demographics, vital signs, and laboratory test values. The rate of preoperative piperacillin-tazobactam administration significantly decreased after the intervention (51.4% preintervention period vs 20.1% postintervention period, P < .001). The rate of surgical site infections was similar in both groups (superficial surgical site infections = 1.4% preintervention period vs 0.8% postintervention period, P = .50; deep surgical site infections = 1.1% preintervention period vs 0.0% postintervention period, P = .06; and organ space surgical site infections = 3.1% preintervention period vs 3.0% postintervention period, P > .99). Rates of 30-day readmission, reoperation, and Clostridioides difficile infection also did not differ between groups. CONCLUSION Our quality improvement intervention successfully decreased piperacillin-tazobactam administration without increasing the rate of surgical site infections in patients with acute appendicitis.
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Affiliation(s)
- Jason Beckermann
- General and Trauma Surgery, Mayo Clinic Health System-Northwest Wisconsin region, Eau Claire, WI.
| | - Maria E Linnaus
- General and Trauma Surgery, Mayo Clinic Health System-Northwest Wisconsin region, Eau Claire, WI
| | | | | | | | | | - Christopher A Kasal
- General Surgery, Mayo Clinic Health System-Southeast Minnesota region, Red Wing, MN
| | - Annaliese G Seidel
- Department of Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Corey J Wachter
- Pharmacy Services, Mayo Clinic Health System-Northwest Wisconsin region, Eau Claire, WI
| | - Kirstin J Kooda
- Pharmacy Services, Critical Care, and General Surgery (Sawyer), Mayo Clinic, Rochester, MN
| | - Jennifer R Rich
- Research & Innovation, Mayo Clinic Health System-Northwest Wisconsin region, Eau Claire, WI
| | - Mark D Sawyer
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN
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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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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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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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Alexandrino da Silva MF, Oliveira Portela FS, Sposato Louzada AC, Teivelis MP, Amaro Junior E, Wolosker N. National Cross-Sectional Epidemiological Analysis of the Impact of Pandemic COVID-19 on Vascular Procedures in Public Health System: 521,069 Procedures Over 4 Years. Ann Vasc Surg 2024; 98:7-17. [PMID: 37717819 DOI: 10.1016/j.avsg.2023.07.103] [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: 06/08/2023] [Revised: 07/09/2023] [Accepted: 07/19/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, there was a dramatic increase in healthcare demand. Resources were redirected to care patients with COVID-19. Therefore, surgical treatments were affected, including those of vascular diseases. There are no studies evaluating the whole impact of the COVID-19 pandemic, considering all types of vascular procedures, both elective and urgent, in a large country. The aim of the present study was to analyze the impact on all types of vascular procedures performed in Brazilian public hospitals during the COVID-19 pandemic. METHODS Cross-sectional population-based analysis of publicly available data referring to vascular procedures. Surgeries 2 years before the pandemic onset (2018-2019) and 2 years during pandemic (2020-2021) were included. RESULTS We observed a total of 521,069 procedures. Decrease was observed in elective abdominal aortic aneurysm repairs both open surgery (P = 0.001) and endovascular surgery (P < 0.001), emergency open abdominal repairs (P = 0.005), elective thoracic aortic aneurysm repairs (P = 0.007), elective open peripheral aneurysm repairs (P = 0.038), carotid endarterectomies (P < 0.001) and angioplasties (P = 0.001), open revascularizations for peripheral arterial disease (P < 0.001), surgical treatment of chronic venous disease (P < 0.001) and sympathectomies for hyperhidrosis (P < 0.001). However, there was an increase of lower limb amputations (P = 0.027) and vena cava filter placements (P = 0.005). There was a reduction of almost US$17 million in financial investments. CONCLUSIONS The reorganization of health systems led to a significant reduction in vascular procedures and decrease in financial investments. On the other hand, there was a significant increase in the number of lower limb amputations and vena cava filter placements.
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Affiliation(s)
- Marcelo Fiorelli Alexandrino da Silva
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Andressa Cristina Sposato Louzada
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Marcelo Passos Teivelis
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Edson Amaro Junior
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Nelson Wolosker
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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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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Soliman SS, Nemeth ZH, Stopper PB, Rolandelli RH. Letter re: Letter in Response to Hossain, N, et al. Hospital Presentations of Acute Diverticulitis During COVID-19 Pandemic may be More Likely to Require Surgery due to Increased Severity: A Single-Centre Experience'. Am Surg 2023; 89:6416-6417. [PMID: 34187176 DOI: 10.1177/00031348211029869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sara S Soliman
- Department of Surgery, Morristown Medical Center, Morristown, NJ, USA
| | - Zoltan H Nemeth
- Department of Surgery, Morristown Medical Center, Morristown, NJ, USA
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Fadgyas B, Őri D, Vajda P. [Effect of the COVID-19 pandemic on the outcome of testicular torsion in children]. Orv Hetil 2023; 164:1367-1372. [PMID: 37660346 DOI: 10.1556/650.2023.32854] [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: 05/17/2023] [Accepted: 06/16/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic influenced not only the elective, but the acute surgeries also, all around the world. Some authors found more delayed cases and more orchiectomies performed in childhood because of testicular torsions during the pandemic. OBJECTIVE To examine the impact of the COVID-19 pandemic on the treatment of childhood testicular torsion and the frequency of semicastration due to torsion at the first author's institute. METHODS A retrospective observational cohort study was performed in a representative Hungarian centre. Boys under 18 years of age operated with testicular torsion were divided into two groups: before COVID-19 (BC; 01/07/2017-31/12/2019) and during COVID-19 (DC; 01/01/2020-30/06/2022) pandemic. PARAMETERS elapsed time between the first symptom and arrival at the hospital (<24 h or >24 h), elapsed time to start the surgical procedure since the arrival to the hospital and the rate of semicastration were analysed. For statistical analysis, Mann-Whitney U and chi2 tests were used. RESULTS During the study period, altogether, 100 patients (45 BC and 55 DC) were operated on testicular torsion. Statistically significant difference was found between the two timeframes: in the elapsed time from the first symptom and arrival at the hospital (p = 0.048). During the pandemic surgeries started earlier (1.5; 2.5 h) than before the pandemic (1.5; 3.25 h, p = 0.01). No difference was found in the frequency of semicastration between the groups (p = 0.594). DISCUSSION Contrary to the literature, during the COVID-19 pandemic, patients with testicular torsion arrived earlier at the hospital, and surgeries were started earlier, than before the pandemic at the investigated institute. CONCLUSION The reason behind this accelerated care pathway might be the absence of less severe cases during the COVID-19 period. When people are more prone to stay home, if it does not seem necessary to seek help for any kind of non-urgent medical problem. Orv Hetil. 2023; 164(35): 1367-1372.
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Affiliation(s)
- Balázs Fadgyas
- 1 Heim Pál Országos Gyermekgyógyászati Intézet, Sebészeti és Traumatológiai Osztály Budapest, Üllői út 86., 1089 Magyarország
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Gyermekgyógyászati Klinika, Manuális Tanszék Pécs Magyarország
| | - Dorottya Őri
- 3 Heim Pál Országos Gyermekgyógyászati Intézet, Mentálhigiéniai Központ Budapest Magyarország
- 4 Semmelweis Egyetem, Általános Orvostudományi Kar, Magatartástudományi Intézet Budapest Magyarország
| | - Péter Vajda
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Gyermekgyógyászati Klinika, Manuális Tanszék Pécs Magyarország
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Lima MIDE, Fonseca Neto OCLDA. Acute abdomen in patients with covid-19: an integrative review. Rev Col Bras Cir 2023; 50:e20233576. [PMID: 37646728 PMCID: PMC10508665 DOI: 10.1590/0100-6991e-20233576-en] [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: 04/22/2023] [Accepted: 06/26/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION upon infection with SARS-CoV-2, patients presented with non-classical symptoms, such as gastrointestinal phenomena including loss of appetite, nausea, vomiting, diarrhea, and abdominal pain abdominal pain. These occurrences, typically, were found in severely affected patients with COVID-19. With this, the aim of this paper is to analyze the available knowledge on the development of acute abdomen in SARS-CoV-2 infected patients. METHODOLOGY this is an Integrative Review in PubMed, Web of Science and VHL databases. The following descriptors were used: "Acute abdomen", "COVID-19", "Abdominal pain" and "SARS-CoV-2" with the Boolean operator "AND", and articles relevant to the theme were selected. Initially, 331 articles were selected, all published between 2020 and 2023, in Portuguese and/or English. After analysis, 11 articles matched the proposed objective. RESULTS the relationship between tenderness in the right upper region or the presence of Murphy's sign contributed in the association between abdominal pain and the more severe forms of COVID-19 in infected patients. The number of diagnoses for acute conditions such as cholecystitis, appendicitis, diverticulitis and pancreatitis decreased with the pandemic, but at the same time there was an increase in the duration of surgical procedures and in the length of hospital stays. These acute abdominal conditions were the result of delayed demand for hospital care, which also contributed to an increase in the conversion rate to open surgery and in the number of perforative conditions. CONCLUSION the development of acute abdomen in SARS-CoV-2 infected patients was predictive of an unfavorable prognosis.
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Affiliation(s)
| | - Olival Cirilo Lucena DA Fonseca Neto
- - Universidade de Pernambuco, Faculdade de Ciências Médicas - Recife - PE - Brasil
- - Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz (HUOC) - Recife - PE - Brasil
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10
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Andersson RE, Agiorgiti M, Bendtsen M. Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid-19 Pandemic: a Systematic Review and Meta-analysis. World J Surg 2023; 47:1901-1916. [PMID: 37140609 PMCID: PMC10158710 DOI: 10.1007/s00268-023-07027-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Reports of an increased proportion of complicated appendicitis during the Covid-19 pandemic suggest a worse outcome due to delay secondary to the restrained access to health care, but may be explained by a concomitant decrease in uncomplicated appendicitis. We analyze the impact of the pandemic on the incidences of complicated and uncomplicated appendicitis. METHOD We did a systematic literature search in the PubMed, Embase and Web Of Science databases on December 21, 2022 with the search terms (appendicitis OR appendectomy) AND ("COVID" OR SARS-Cov2 OR "coronavirus"). Studies reporting the number of complicated and uncomplicated appendicitis during identical calendar periods in 2020 and the pre-pandemic year(s) were included. Reports with indications suggesting a change in how the patients were diagnosed and managed between the two periods were excluded. No protocol was prepared in advance. We did random effects meta-analysis of the change in proportion of complicated appendicitis, expressed as the risk ratio (RR), and of the change in number of patients with complicated and uncomplicated appendicitis during the pandemic compared with pre-pandemic periods, expressed as the incidence ratio (IR). We did separate analyses for studies based on single- and multi-center and regional data, age-categories and prehospital delay. RESULTS The meta-analysis of 100,059 patients in 63 reports from 25 countries shows an increase in the proportion of complicated appendicitis during the pandemic period (RR 1.39, 95% confidence interval (95% CI 1.25, 1.53). This was mainly explained by a decreased incidence of uncomplicated appendicitis (incidence ratio (IR) 0.66, 95% CI 0.59, 0.73). No increase in complicated appendicitis was seen in multi-center and regional reports combined (IR 0.98, 95% CI 0.90, 1.07). CONCLUSION The increased proportion of complicated appendicitis during Covid-19 is explained by a decrease in the incidence of uncomplicated appendicitis, whereas the incidence of complicated appendicitis remained stable. This result is more evident in the multi-center and regional based reports. This suggests an increase in spontaneously resolving appendicitis due to the restrained access to health care. This has important principal implications for the management of patients with suspected appendicitis.
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Affiliation(s)
- Roland E Andersson
- Department of Surgery, County Hospital Ryhov, Box 1024, SE 551 11, Jönköping, Region Jönköpings Län, Sweden.
- Futurum, Academy for Health and Care, Jönköping, Region Jönköpings Län, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Maria Agiorgiti
- Bra Liv Eksjö Primary Care Centre, Eksjö, Region Jönköping County, Sweden
- Department of Experimental Physiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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11
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Akrida I, Verras GI, Bouchagier K, Kehagias D, Kaplanis C, Tasios K, Antzoulas A, Samaras A, Benetatos N, Maroulis I, Mulita F. The impact of the COVID-19 pandemic on the number of patients presenting with appendicitis to the emergency department. PRZEGLAD GASTROENTEROLOGICZNY 2023; 19:194-197. [PMID: 38939065 PMCID: PMC11200070 DOI: 10.5114/pg.2023.129495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 06/29/2024]
Abstract
Introduction The COVID-19 pandemic has had an influence on the number of patients presenting to the emergency department (ED) with surgical conditions. Aim To evaluate the number of patients presenting with acute appendicitis (AA) and the percentage of complicated appendicitis before and after the COVID-19 disease outbreak. Material and methods This is a retrospective study based on the data of all patients presenting with AA to the ED of a tertiary COVID referral university hospital in Greece. We analysed the number of patients treated with AA, patient characteristics, and the proportion of patients with complicated appendicitis, and we compared the 2 groups of patients treated 12 months before and 12 months after COVID-19 onset in Greece. Results A total of 152 patients were included in this study. There was a significant decrease in the number of patients presenting with AA after COVID-19 onset in Greece. Respectively, 91 and 61 patients were subjected to appendectomy 12 months before and after COVID-19 onset. Comparing the 2 groups of patients, there was a statistically significant increase in the operation time (p = 0.01) after COVID-19 onset, whereas the percentage of complicated appendicitis, the duration of symptoms before presenting to the ED (< 24 h, > 24 h), and the type of operation (laparoscopic, open, converted) did not differ significantly between the 2 groups of patients. Conclusions The number of patients presenting to the ED with AA decreased after COVID-19 onset, most likely because patients hesitated to seek help in a COVID-19 referral hospital.
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Affiliation(s)
- Ioanna Akrida
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | | | - Dimitrios Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Angelos Samaras
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Nikolaos Benetatos
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Ioannis Maroulis
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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12
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Chen Y, Fan Z, Zhang X, Fu X, Li J, Yuan J, Guo S. A brief overview of single-port laparoscopic appendectomy as an optimal surgical procedure for patients with acute appendicitis: still a long way to go. J Int Med Res 2023; 51:3000605231183781. [PMID: 37466195 PMCID: PMC10363874 DOI: 10.1177/03000605231183781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Single-port laparoscopic appendectomy (SPLA) has become a good alternative to the traditional surgical treatment of acute appendicitis, due to its advantages of small incision, mild postoperative pain, short hospital stay, and good cosmetic effect. However, the further application of SPLA has been restricted by its relatively long operating time, high level of operating difficulty, and increased equipment and technical requirements. Clinical teams worldwide have attempted to improve and optimize SPLA technical protocols and equipment to maintain stable intraoperative pneumoperitoneal pressure, improve the 'triangle relationship' of operating angles, and develop new surgical procedures with less trauma and higher cost-effectiveness. Here, new SPLA techniques reported over the past decade are reviewed and compared, with the aim of providing new insights into technical improvements, equipment upgrades and clinical studies in the coming years.
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Affiliation(s)
- Yang Chen
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
| | - Zongqi Fan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xiaoxin Zhang
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xinao Fu
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, China Medical University, Shenyang, Liaoning Province, China
| | - Jushang Li
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, China Medical University, Shenyang, Liaoning Province, China
| | - Jieqing Yuan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
| | - Shigang Guo
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
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13
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Kaselas C, Florou M, Tsopozidi M, Spyridakis I. Acute Appendicitis Following COVID-19 Infection in Pediatric Patients: A Single Center's Study in Greece. Diagnostics (Basel) 2023; 13:2070. [PMID: 37370965 PMCID: PMC10297295 DOI: 10.3390/diagnostics13122070] [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: 03/31/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE This study investigated the potential association between the previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive infection, as well as vaccination, and the presentation of acute appendicitis in pediatric patients. It has been three years since the World Health Organization (WHO) declared the SARS-CoV-2 pandemic, and city lockdowns and self-protective measures have been applied worldwide. In an effort to contribute to the research on the probable long-term complications of the COVID-19 infection as well as the vaccination against SARS-CoV-2, the current study was designed and investigated patients' health records in the post-quarantine era. METHODS A retrospective analysis of patients admitted and treated surgically for acute appendicitis from January 2022 to June 2022 was conducted. Demographic and personal data, as well as the COVID-19 infection history of each child, were recorded. The patients who were negative for a previous COVID-19 infection were excluded. For the rest of the sample, the time-to-onset of acute appendicitis, the severity of appendicitis (complicated or uncomplicated), and the vaccination status of the patients were examined. Regarding the time-to-onset of appendicitis, we divided the patients into three groups: group A with a time-to-onset < 3 months, group B with a time-to-onset of 3-6 months, and group C with a time-to-onset of >6 months. Statistical analysis followed and was considered significant if p < 0.05. RESULTS Sixty-six children with a mean age of 10.5 years (range 1-15 years) were admitted for acute appendicitis during the determined period. After excluding 30 children that were negative for previous COVID-19 infection, we divided the patients into three groups: group A-23 children, group B-7 children, and group C-6 children. A statistically significant incidence of acute appendicitis diagnosis in <3 months after laboratory-confirmed COVID-19 infection (p < 0.01) was found. The incidence of complicated appendicitis was greater in patients with a positive SARS-CoV-2 history, with an estimated odds ratio of 1.8 (p > 0.05). The majority of the children (92%) had not received a COVID-19 vaccination. For the vaccinated children, the relative risk for complicated appendicitis was equal to 1.5 (p > 0.05). CONCLUSIONS The results of our study demonstrate a potential positive relationship between COVID-19 infection and subsequent acute appendicitis in pediatric patients. There are also some speculations on the presentation of complicated cases of appendicitis following COVID-19 infection or vaccination, but these need to be further proven. Further data are required to better understand this potential complication of COVID-19 infection as well as the role of vaccines in the current post-vaccine era.
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Affiliation(s)
| | - Maria Florou
- Second Department of Pediatric Surgery, Aristotle University of Thessaloniki, “Papageorgiou’’ General Hospital Thessaloniki, 54124 Thessaloniki, Greece
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14
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Andric M, Stockheim J, Rahimli M, Klös M, Esser T, Soldatovic I, Dölling M, Al-Madhi S, Acciuffi S, Croner R, Perrakis A. Management of acute appendicitis during COVID-19 pandemic. Single center data from a tertiary care hospital in Germany. Innov Surg Sci 2023; 8:39-48. [PMID: 38058775 PMCID: PMC10696938 DOI: 10.1515/iss-2022-0021] [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: 10/14/2022] [Accepted: 04/03/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives The unexpected global overload of the health system during COVID-19 pandemic has caused changes in management of acute appendicitis worldwide. Whereas conservative treatment was widely recommended, the appendicectomy remained standard therapy in Germany. We aimed to investigate the impact of COVID-19 pandemic on treatment routine for acute appendicitis at University Hospital of Magdeburg. Methods Adult patients with clinical and/or radiological diagnosis of acute appendicitis were included in the single center retrospective study. Data was collected to patient demographics, treatment modality and outcomes including morbidity and length of stay. The patient data related to COVID-19 period from March 22, 2020 to December 31, 2021 (649 days) were compared to the Non-COVID-19 period from June 12, 2018 to March 21, 2020 (649 days). Subgroup analysis related to conservative or surgical treatment has been performed. Results A total of 385 patients was included in the study, 203 (52.73 %) during Non-COVID-19 period and 182 (47.27 %) during COVID-19 period. Mean age of entire collective was 43.28 years, containing 43.9 % female patients (p=0.095). Conservative treatment was accomplished in 49 patients (12.7 % of entire collective), increasing from 9.9 % to 15.9 % during COVID-19 period (p=0.074). Laparoscopic appendicectomy was performed in 99.3 % (n=152) of operated patients during COVID-19 period (p=0.013), followed by less postoperative complications compared to reference period (23.5 % vs. 13.1 %, p=0.015). The initiation of antibiotic therapy after the diagnosis increased from 37.9 % to 53.3 % (p=0.002) during COVID-19 period regardless the following treatment modality. Antibiotic treatment showed shorter duration during pandemic period (5.57 days vs. 3.16 days, p<0.001) and it was given longer in the conservative treatment group (5.63 days vs. 4.26 days, p=0.02). The overall length of stay was shorter during COVID-19 period (4.67 days vs. 4.12 days, p=0.052) and in the conservative treatment group (3.08 days vs. 4.47 days, p<0.001). However, the overall morbidity was lower during the COVID-19 period than before (17.2 % vs. 7.7 %, p=0.005) and for conservative therapy compared to appendicectomy (2 % vs. 14.3 %, p=0.016). There was no mortality documented. Conclusions According to our findings the COVID-19 pandemic had a relevant impact on treatment of acute appendicitis, but it was possible to maintain the traditional diagnostic and treatment pathway. Although laparoscopic appendicectomy remains a recommended procedure, the conservative treatment of uncomplicated appendicitis with excellent short-term outcome can be a safe alternative to surgery during potential new wave of COVID-19 pandemic and in the daily routine.
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Affiliation(s)
- Mihailo Andric
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jessica Stockheim
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Mirhasan Rahimli
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Michael Klös
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Torben Esser
- Institute of Microbiology and Hospital Hygiene, University Hospital Magdeburg, Magdeburg, Germany
| | - Ivan Soldatovic
- Institute for Medical statistics, Faculty of Medicine, University Belgrade, Belgrade, Serbia
| | - Maximilian Dölling
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Sara Al-Madhi
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Sara Acciuffi
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Roland Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
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15
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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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16
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Kim H, Kang BM. Impact of the COVID-19 pandemic on the outcomes of laparoscopic appendectomy for acute appendicitis. Ann Surg Treat Res 2023; 104:274-280. [PMID: 37179695 PMCID: PMC10172030 DOI: 10.4174/astr.2023.104.5.274] [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: 01/26/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
Purpose This retrospective study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the time interval from symptom onset to surgery and on the operative outcomes of laparoscopic appendectomy for patients with acute appendicitis. Methods Between October 2018 and July 2021, laparoscopic appendectomy was performed in 502 patients with acute appendicitis admitted to Hallym University Chuncheon Sacred Heart Hospital in Chuncheon, Korea. We compared demographic data, serum levels of inflammatory markers, time to event of appendicitis, and operative outcomes between the pre-COVID-19 and post-COVID-19 pandemic groups. Results Laparoscopic appendectomy was performed in 271 patients in the pre-COVID-19 group and in 231 patients in the post-COVID-19 group. There were no differences in baseline characteristics, serum inflammatory marker levels, or the proportions of complicated appendicitis between the groups (25.1%, pre-COVID-19 vs. 31.6%, post-COVID-19; P = 0.106). The time intervals between symptom onset and hospital arrival (24.42 hours vs. 23.59 hours, P = 0.743) and between hospital arrival and the start of surgery (10.12 hours vs. 9.04 hours, P = 0.246) did not increase post-COVID-19. The overall 30-day postoperative complication rate did not differ significantly between the groups (9.6% vs. 10.8%, P = 0.650), and the severity of 30-day postoperative complications was also similar in both groups (P = 0.447). Conclusion This study demonstrates that hospitalization and surgeries were not delayed in patients with acute appendicitis and that the operative outcomes of laparoscopic appendectomy did not worsen despite the COVID-19 pandemic.
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Affiliation(s)
- Hanbaro Kim
- Department of Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Byung Mo Kang
- Department of Surgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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17
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Waldman R, Kaplan H, Leitman IM. Were surgical outcomes for acute appendicitis impacted by the COVID-19 pandemic? BMC Surg 2023; 23:43. [PMID: 36823569 PMCID: PMC9948783 DOI: 10.1186/s12893-023-01930-x] [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: 08/28/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted healthcare systems throughout the world. We examine whether appendectomy outcomes in 2020 and 2021 were affected by the pandemic. METHODS We conducted a retrospective cohort study of 30-day appendectomy outcomes using the ACS-NSQIP database from 2019 through 2021. Logistic regression and linear regression analyses were performed to create models of post-operative outcomes. RESULTS There were no associations between the time period of surgery and death, readmission, reoperation, deep incisional SSI, organ space SSI, sepsis, septic shock, rate of complicated appendicitis, failure to wean from the ventilator, or days from admission to operation. During the first 21 months of the pandemic (April 2020 through December 2021), there was a decreased length of hospital stay (p = 0.016), increased operative time (p < 0.001), and increased likelihood of laparoscopic versus open surgery (p < 0.001) in compared to 2019. CONCLUSIONS There were minimal differences in emergent appendectomy outcomes during the first 21 months of the pandemic when compared to 2019. Surgical systems in the US successfully adapted to the challenges presented by the COVID-19 pandemic.
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Affiliation(s)
- Rachel Waldman
- grid.59734.3c0000 0001 0670 2351Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1076, New York, NY 10029 USA
| | - Harrison Kaplan
- grid.59734.3c0000 0001 0670 2351Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1076, New York, NY 10029 USA
| | - I. Michael Leitman
- grid.59734.3c0000 0001 0670 2351Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1076, New York, NY 10029 USA
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18
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Lescinska AM, Sondore E, Ptasnuka M, Mukans M, Plaudis H. The Course and Surgical Treatment of Acute Appendicitis during the First and Second Wave of the COVID-19 Pandemic: A Retrospective Analysis in University Affiliated Hospital in Latvia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020295. [PMID: 36837497 PMCID: PMC9966030 DOI: 10.3390/medicina59020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023]
Abstract
Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring surgery and it has an estimated lifetime risk of 6.7 to 8.6%. The COVID-19 pandemic has transformed medical care worldwide, influencing diagnostic tactics, treatment modalities and outcomes. Our study aims to compare and analyze management of acute appendicitis before and during the first and second waves of the pandemic. Materials and Methods: Patients suffering acute appendicitis were enrolled retrospectively in a single-center study for a 10-month period before the pandemic (pre-COVID-19 period: 1 March to 31 December 2019) and during the pandemic (COVID-19 period: 1 March to 31 December 2020). The total number of patients, disease severity, diagnostic methods, complications, length of hospitalization and outcomes were analyzed. Results: A total number of 863 patients were included, 454 patients in the pre-COVID-19 period and 409 patients in the COVID-19 period. Compared to the pre-COVID-19 period, the number of complicated appendicitis increased in the COVID-19 period (24.4% to 37.2%; p < 0.001). The proportion of laparoscopic appendectomies increased during the COVID-19 period but did not show statistically significant differences between periods. In both time periods, we found that open technique was the chosen surgical approach more frequently in elderly patients (p < 0.001). Generalized peritonitis was significantly more common during the COVID-19 period (3.5% vs. 6.1%, p < 0.001). The postoperative course of patients was similar in the pre-COVID-19 period and during the COVID-19 period, with no significant differences in ICU admissions, overall hospital stay or morbidity. Conclusions: The COVID-19 pandemic has led to a significant increase in complicated forms of acute appendicitis; however, no significant impact was observed in terms of diagnostic or treatment approach.
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Affiliation(s)
- Anna Marija Lescinska
- Faculty of Medicine, University of Latvia, LV-1004 Riga, Latvia
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
- Correspondence: ; Tel.: +371-29258517
| | - Elza Sondore
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Margarita Ptasnuka
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Maksims Mukans
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
| | - Haralds Plaudis
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Department of General and Emergency Surgery, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
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Segnini-Rodríguez FJ, Vega-Peña NV, Gamboa MP, Domínguez LC, Lotero JD, Flórez MS. Estudio de los desenlaces perioperatorios de la apendicitis aguda durante la pandemia por COVID-19: un estudio observacional analítico de cohorte. REVISTA COLOMBIANA DE CIRUGÍA 2023. [DOI: 10.30944/20117582.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Introducción. La condición de pandemia por COVID-19 impactó a la sociedad y los sistemas de salud a nivel mundial. Las adaptaciones institucionales procuraron mantener la calidad de la atención a pesar de un contexto organizacional desfavorable. La apendicitis aguda requirió ser manejada en un nuevo escenario institucional. El objetivo de este estudio fue evaluar la efectividad del tratamiento quirúrgico de la apendicitis durante la pandemia.
Métodos. Estudio observacional analítico, retrospectivo, en el que se incluyeron pacientes sometidos a apendicectomía, antes y durante la pandemia por COVID-19. Se evaluaron las complicaciones, infección del sitio operatorio, reingresos y estancia hospitalaria. Adicionalmente, se analizaron los desenlaces en los 3 picos epidemiológicos de la pandemia. Se efectuaron estadísticas descriptivas y analíticas entre los grupos a comparar.
Resultados. Se incluyeron 1521 pacientes con apendicitis, 48,3 % operados antes y 51,7 % durante la pandemia. No hubo diferencias entre los grupos en complicaciones (p=0,352), infección del sitio operatorio (p=0,191), reingreso en los primeros 30 días (p=0,605) y estancia hospitalaria (p=0,514). El manejo de la apendicitis durante el tercer pico fue similar a las prácticas habituales. El tiempo de evolución fue mayor durante la pandemia (p=0,04) y los pacientes fueron llevados a cirugía más pronto que previo a la pandemia (p<0,001). > <0,001).
Conclusiones. No se evidenció un incremento de complicaciones quirúrgicas, reingresos, estancia hospitalaria ni infección del sitio operatorio en los pacientes operados durante la pandemia. Hubo un efecto favorable para los pacientes como consecuencia de la adaptación institucional en la pandemia por COVID-19.
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Takagi T, Kinoshita S, Kawaguchi C, Ohyama T. Delayed Presentation and Referral Time from General Practitioners Contribute to Increased Complicated Appendicitis during the Initial COVID-19 Pandemic Period in Japan. J Anus Rectum Colon 2023; 7:17-24. [PMID: 36743468 PMCID: PMC9876603 DOI: 10.23922/jarc.2022-029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives This study aims to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the situation of acute appendicitis (AA) with respect to patients' and general practitioners' behaviors in a general community hospital in Japan. Methods The surgical outcomes and periods from symptom onset to medical presentation besides practitioners' referral time for consecutive AA patients were compared between the control (January 2016 to March 2020) and COVID-19 periods (April 2020 to April 2021). Results Eighty-three patients who underwent emergency surgery for AA were reviewed. Complicated appendicitis significantly increased in the COVID-19 period (63.6% vs. 31.2%, P = 0.023). In the COVID-19 period, the time from symptom onset to the medical presentation (2.2 vs. 0.9 days, P < 0.001) was significantly longer than in the control period. Among the patients who first presented to a general practitioner, the referral time from the practitioner to our hospital was significantly longer in the COVID-19 period (1.6 vs. 0.7 days, P = 0.017). Furthermore, among patients with a fever of higher than 38°C at medical presentation, the time from symptom onset to medical presentation was significantly longer in the COVID-19 period (3.0 vs. 0.7 days, P = 0.015). There was no difference in severe postoperative complications. Conclusions Hesitation to seek surgical treatment for AA was seen in both the patients and practitioners in the COVID-19 period. The delay in surgical treatment presumably led to the increase in severe AA. In a pandemic era, timely care for emergent conditions is a crucial challenge.
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Affiliation(s)
- Tadataka Takagi
- Department of Surgery, Heisei Memorial Hospital, Kashihara, Japan
| | | | | | - Takao Ohyama
- Department of Surgery, Heisei Memorial Hospital, Kashihara, Japan
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Londoño-Ruiz JP, Gutierrez-Tobar IF, Bermúdez-Bohórquez NL, Rodríguez AE. First publication of endemic channels as part of a pediatric Antimicrobial Stewardship Program: when to turn on the alarms? Recommendations of a pediatric ASP program. BMC Infect Dis 2023; 23:21. [PMID: 36631755 PMCID: PMC9833633 DOI: 10.1186/s12879-022-07916-z] [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: 06/27/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pediatric Antimicrobial Stewardship Programs (ASP) consider DOT a fundamental measure to quantify the impact of ASP. Novel strategies have been described, but no endemic channels (EC) have been reported to compare antibiotic use within historical patterns. This report describes the process of constructing an EC and analyzing its interpretation. METHODS This was a descriptive study of the construction, implementation, and analysis of EC. The median and quartile method, as well as the geometric mean (GM) and confidence interval (CI) methods using DOT for the last 4 years were used. ECs have also been elaborated on in critical services (PICU). RESULTS GM and CI method seem to be more sensitive in identifying changes in antimicrobial use. Ceftriaxone increased its use starting in December 2021, reaching the warning zone in March 2022 in relation to increased cases of bacterial and complicated pneumonia. Piperacillin-tazobactam showed an important increase in PICU during the first 8 months of 2021, reaching the alert zone until August 2021; thereafter, its use decreased, and this variation was related to a modification in the presentation of complicated appendicitis during the COVID 19 pandemic restrictions. The use of ampicillin-sulbactam has increased since January 2022 because of a change in local guidelines regarding its use in appendicitis and peritonitis. The changes identified in each EC allowed ASP to take different conducts. CONCLUSION EC allowed us to construct a new tool to measure ASP impact, internal comparison of antibiotic use facilitated taking timely interventions. EC could be useful for all pediatric and adult ASP.
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Affiliation(s)
- Juan Pablo Londoño-Ruiz
- Antimicrobial Stewardship Program, Clinica Infantil Colsubsidio, Bogotá, Colombia ,Pediatric Infectious Diseases, Clinica Infantil Santa Maria del Lago, Bogotá, Colombia ,grid.412191.e0000 0001 2205 5940Department of Pediatrics, Universidad del Rosario, Bogota, Colombia
| | - Ivan Felipe Gutierrez-Tobar
- Antimicrobial Stewardship Program, Clinica Infantil Colsubsidio, Bogotá, Colombia ,Pediatric Infectious Diseases, Clinica Infantil Santa Maria del Lago, Bogotá, Colombia
| | - Naddya Lheidy Bermúdez-Bohórquez
- Antimicrobial Stewardship Program, Clinica Infantil Colsubsidio, Bogotá, Colombia ,Pharmacy Department, Clinica Infantil Colsubsidio, Bogotá, Colombia
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Wiseman SM, Leong R, Lee D, Nabata K. Bibliometric analysis of the classic cited papers in the American Journal of Surgery: Citation recapitulates surgical history. Am J Surg 2023; 225:832-840. [PMID: 36635132 DOI: 10.1016/j.amjsurg.2023.01.005] [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: 12/09/2022] [Accepted: 01/06/2023] [Indexed: 01/08/2023]
Abstract
BACKGROUND We performed a bibliometric analysis of the American Journal of Surgery (AJS) to identify, characterize and place within a historical context, its published classic cited papers (CCPs). METHODS Bibliometric data from papers published in the AJS between January 1, 1945, and December 31, 2021 was extracted from the Web of Science database. Analysis was performed utilizing Bibliometrix and VOSViewer software. RESULTS 27,070 papers were published in the AJS over the study period. There were 16 CCPs, including 5 Top CCPs, identified. Review of the Top CCPs reveals that they are based on careful clinical observations, innovation and generally build on prior published work. Top CCPs usually are specific to a particular diagnosis or a commonly performed procedure, as such papers frequently present a scoring or classification system, or important details related to new operative approaches or techniques. CONCLUSIONS Bibliometric study of the AJS has allowed for identification, characterization and appreciation of many of the key changes that have occurred in the discipline throughout the history of modern surgery.
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Affiliation(s)
- Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada.
| | - Rachel Leong
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Debon Lee
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Kylie Nabata
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
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23
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The impact of the COVID-19 pandemic on ectopic pregnancy presentation and treatment: A retrospective cohort study. J Gynecol Obstet Hum Reprod 2023; 52:102508. [PMID: 36384217 PMCID: PMC9659410 DOI: 10.1016/j.jogoh.2022.102508] [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: 07/24/2022] [Revised: 10/17/2022] [Accepted: 11/12/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined ectopic pregnancy (EP) incidence, presentation and management, before and during the COVID-19 pandemic, and following initiation of vaccination against COVID-19. STUDY DESIGN In a single-center retrospective cohort study, we compared incidence, presentation and management of EP, between 98 women who presented during the pandemic (March 1 2020 to August 31, 2021), and 94 women diagnosed earlier (March 1 2018 to August 31, 2019). Sub-periods before and after introduction of the vaccination were compared. RESULTS Age and parity were similar between the periods. For the pandemic compared to the earlier period, the median gestational age at EP presentation was higher (6.24 ± 1.25 vs. 5.59 ± 1.24, P<0.001), and the proportions were higher of symptomatic women (42.9% vs. 27.7%, p = 0.035) and urgent laparoscopies (42.9% vs. 24.5%, p = 0.038). In a multivariable linear model, women who presented during the pandemic were more likely to undergo an urgent laparoscopy [OR 2.30, 95%CI (1.20-4.41)], P = 0.012. In urgent surgeries performed during the pandemic compared to the earlier period, the proportion of women with a hemoglobin drop >2 gr/dL was greater (60% vs. 30%, p = 0.024). Statistically significant differences were not found in sonographic or laboratory findings, in rupture or massive hemoperitoneum rates, or in the need for blood transfusion in urgent laparoscopy. Outcomes were similar before and after introduction of vaccinations. CONCLUSION During the pandemic, and even after the introduction of vaccination, women with EP were more likely to undergo urgent surgery, and blood loss was greater. This is likely due to delayed diagnosis.
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Saldaña CZ, Gutiérrez EG, Carlos ZC, Jose CA, Jean AV, Alejandro LP, Lopez CS. [Factors associated with prolonged hospital-stay after appendectomy during the SARS-CoV-2 pandemic]. Khirurgiia (Mosk) 2023:47-52. [PMID: 37916557 DOI: 10.17116/hirurgia202310147] [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
OBJECTIVE To determine the factors associated with prolonged hospital-stay after appendectomy in SARS-CoV-2 pandemic. MATERIAL AND METHODS A retrospective observational cohort study included 420 patients after surgery for acute appendicitis between March 2019 and March 2020, April 2020 and April 2021. There were 336 patients before the SARS-COV-2 pandemic, and 84 ones underwent surgery during the pandemic. RESULTS Incidence of prolonged hospital stay was 15% and 26%, respectively (RR 1.76). RR is more than 1 and assumes SARS-CoV-2 infection as a risk factor. CONCLUSION There is an association between SARS-CoV-2 infection and prolonged hospital-stay after surgery for acute appendicitis (RR 1.76).
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Affiliation(s)
- C Z Saldaña
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - E G Gutiérrez
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - Z C Carlos
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - C-A Jose
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - A V Jean
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - L P Alejandro
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - C S Lopez
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
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Plekhanov AN, Tovarshinov AI, Plekhanov NA. [Features of surgical patients of COVID-19 patients]. Khirurgiia (Mosk) 2023:51-56. [PMID: 37379405 DOI: 10.17116/hirurgia202307151] [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: 06/30/2023]
Abstract
The novel coronavirus pandemic has significantly increased the workload of surgical service worldwide. Restrictive measures led to postponement of elective surgical and diagnostic interventions and reduced the number of emergency manipulations around the world. Large-scale studies identified optimal period for postponing surgical procedures and advisability of this postponement. The authors present opinions of surgeons and their views on treatment strategy for various elective and emergency surgical interventions in abdominal surgery, traumatology-orthopedics and oncology. The main factors reducing perioperative mortality in patients with a new coronavirus infection are observance of anti-epidemic measures by patients and medical personnel, competent use of personal protective equipment, as well as adherence to protocols and algorithms for the treatment of these patients.
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Affiliation(s)
- A N Plekhanov
- Dorzhi Banzarov Buryat State University, Ulan-Ude, Russia
- Irkutsk Research Center for Surgery and Traumatology, Irkutsk, Russia
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[Emergency missions in Tyrol in spring 2020 : Influence of COVID-19-A retrospective observational study focusing on air rescue]. DIE ANAESTHESIOLOGIE 2023; 72:21-27. [PMID: 36301309 PMCID: PMC9610328 DOI: 10.1007/s00101-022-01212-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/23/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tyrol, a province of Austria with about 760,000 inhabitants, was one of the first regions in Europe, along with northern Italy, to be affected by the pandemic spread of the coronavirus in spring 2020. A lockdown with far-reaching restrictions in all areas of life occurred from 16 March 2020. Restrictions were imposed in the areas of gastronomy, trade and free mobility as well as in recreational sports. The ski resorts were closed and due to the strong winter tourism in Tyrol, this meant that about 340,000 people left the region. In the province of Tyrol comprehensive emergency medical care is provided by 13 ground-based emergency medical systems (NEF) in combination with air rescue (16 emergency medical helicopters, some of which are seasonal). Normally, this system provides emergency medical care for approx. 1 million people; however, in spring 2020 during the first lockdown, the number of people to be cared for was approx. 30% less. In order to protect the emergency medical teams as best as possible from infections and thus the system from failures, the Integrated Control Center Tyrol (Landesleitstelle Tirol GmbH) adapted the release order for emergency medical resources. The aim of the study is to describe the influence of the pandemic in spring 2020 on the emergency medical services in Tyrol in comparison to the three preceding years. METHODS A retrospective survey of all emergency helicopter missions and ground-based emergency physician missions in Tyrol in the period 15 March 2020-15 May 2020, as well as in the same period of the previous years 2017-2019, was conducted. Detailed figures on medical procedures and patient-related data were collected from 6 ÖAMTC helicopter bases. In addition, all ground-based emergency physician missions from all 13 physician systems including appeal mission diagnoses were collected in the same period. RESULTS The total number of emergency helicopter missions and ground-based emergency physician missions showed a significant decrease during the observational period (67.3% and 39.8%, respectively). In the area of ground-based emergency medical resources, there was a significant increase in respiratory and CNS diseases during the observational period. The range of emergency helicopter missions showed a significant shift from sports and leisure missions to internal medicine and neurological emergencies and the duration of missions was significantly longer. The NACA score was higher with a significant decrease in NACA 3 scores in favor of NACA 4 and 5. The circulatory status of patients during the observational period was significantly more often documented as unstable. Hypertension, impending shock and circulatory arrest occurred more frequently in the trend. Cardiac massage, oxygen administration, circulatory drugs and specific monitoring were used more frequently in 2020. Analgesics were administered less frequently. In air rescue, there was no infection of rescue workers in the field. CONCLUSION The first pandemic wave in Tyrol and the consecutive lockdown from 16 March 2020 had a massive impact on emergency medical care in Tyrol, both quantitatively and in terms of the spectrum of operations and emergency medical interventions. The decline in patient numbers was highly relevant, especially in air rescue and can be explained in part by the discontinuation of tourism, the general exit restrictions and the restrictive disengagement order. This decline primarily affected patients in the NACA 3 category and the analgesic administration measure. The patients treated had a higher NACA score and the emergency procedures were more extensive during the observational period. The measures to protect the emergency helicopter team from infections were presumably successful as no infections occurred.
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Effects of COVID-19 Pandemic on the Frequency of Complicated Appendicitis in Pediatric Populations. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2023. [DOI: 10.5812/pedinfect-129026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: The clinical course of acute appendicitis, one of the most common diseases needing surgical intervention in children, was affected by the coronavirus disease 2019 (COVID-19) pandemic. The global fear and panic about the outbreak and governmental decisions on lockdowns and restrictions led to an increasing number of complicated forms of appendicitis. Objectives: This study aimed to compare different aspects of appendicitis and its complications between the pre-pandemic and pandemic periods. Methods: In a retrospective cross-sectional analytical study, we enrolled all patients with a diagnosis of acute appendicitis for two consecutive years. Only children under 14 years of age were included in the study. The patients were divided into two groups based on the time of disease presentation, the pre-pandemic and pandemic periods. Demographic features, as well as clinical, laboratory, and imaging findings, were compared between the two groups. Results: Out of 369 patients included in the study, 173 were placed in the pre-pandemic group. There was no significant change in the incidence of appendicitis between the two periods (P = 0.232). However, the incidence of complicated appendicitis increased remarkably during the pandemic (27% vs. 11%, P < 0.001). No substantial differences were found in parameters like age, sex, laboratory findings, and the length of hospital stay between the two groups (P > 0.005). The patients who tested positive for COVID-19 had a significantly higher hospitalization duration (P < 0.001). Conclusions: Our results suggested that the rate of complicated appendicitis was substantially higher during the pandemic compared to the pre-pandemic time. Also, the proportion of midline laparotomy was significantly higher after the outbreak. These findings suggested that delays in care provision during the COVID-19 outbreak could have probably contributed to the rise in the incidence of complicated appendicitis in children.
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Mangus CW, Parker SJ, DeLaroche AM, Zhang X, Gunnink S, Hayes J, Heath G, Michiels E, Mahajan P. Impact of COVID-19 on the associated complications of high-risk conditions in a statewide pediatric emergency network. J Am Coll Emerg Physicians Open 2022; 3:e12865. [PMID: 36540333 PMCID: PMC9753814 DOI: 10.1002/emp2.12865] [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: 08/29/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic affected the volume and epidemiology of pediatric emergency department (ED) visits. We aimed to determine the rate of associated complications for 16 high-risk conditions in a Michigan statewide network of academic and community EDs during the pandemic. METHODS We conducted a cross-sectional study of pediatric ED visits among a network of 5 Michigan health systems during the pre-pandemic (March 1, 2019-March 10, 2020) and pandemic (March 11, 2020-March 31, 2021) periods. Data were collected from the medical record and included patient demographics, ED visit characteristics, procedure codes, and final International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes. Selection of codes for 16 high-risk conditions and diagnostic complications were identified using previously described methods. Characteristics of ED visits were compared before versus during the pandemic using χ2 and Fisher's exact tests. We used multilevel logistic regression to analyze covariates and potential confounders for being diagnosed with a high-risk condition or a complication of a high-risk condition. RESULTS A total of 417,038 pediatric ED visits were analyzed. The proportion of patients presenting with 10 of 16 high-risk conditions (including appendicitis, sepsis, and stroke) was higher in the pandemic period compared with pre-pandemic (P < 0.01). Despite this, there was no significant increase in the frequency of complications for any of the 16 high-risk conditions during the pandemic. The adjusted odds of being diagnosed with appendicitis (pre-pandemic 0.23% vs pandemic 0.52%; odds ratio [OR], 1.19 [95% confidence interval, CI, 1.00-1.41]), diabetic ketoacidosis (pre-pandemic 0.16% vs pandemic 0.52%; OR, 2.40 [95% CI, 2.07-2.78]), intussusception (pre-pandemic 0.05% vs pandemic 0.07%; OR, 1.64 [95% CI, 1.22-2.21)], and testicular torsion (pre-pandemic 0.10% vs pandemic 0.14%; OR, 1.64 [95% CI, 1.18-2.28]) was higher during the pandemic. CONCLUSIONS Despite a higher proportion of ED visits attributed to high-risk conditions, there was no increase in complications, suggesting minimal impact of the pandemic on outcomes of pediatric ED visits.
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Affiliation(s)
- Courtney W. Mangus
- Department of Emergency MedicineUniversity of MichiganAnn ArborMichiganUSA,Department of PediatricsUniversity of MichiganAnn ArborMichiganUSA
| | - Sarah J. Parker
- Department of Emergency MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Amy M. DeLaroche
- Division of Pediatric Emergency Medicine, Department of PediatricsChildren's Hospital of MichiganDetroitMichiganUSA
| | - Xingyu Zhang
- Thomas E. Starzl Transplantation InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA,Department of NursingUniversity of MichiganAnn ArborMichiganUSA
| | - Stephen Gunnink
- Department of Emergency Medicine, Helen DeVos Children's HospitalMichigan State University College of Human MedicineGrand RapidsMichiganUSA
| | - Julia Hayes
- Department of Emergency MedicineHenry Ford HospitalDetroitMichiganUSA
| | - Gerard Heath
- Department of Emergency MedicineHenry Ford HospitalDetroitMichiganUSA
| | - Erica Michiels
- Department of Emergency Medicine, Helen DeVos Children's HospitalMichigan State University College of Human MedicineGrand RapidsMichiganUSA
| | - Prashant Mahajan
- Department of Emergency MedicineUniversity of MichiganAnn ArborMichiganUSA,Department of PediatricsUniversity of MichiganAnn ArborMichiganUSA
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Unny AK, Rajashree P, Sundararajan L, Sankar J. Abdominal Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Experience. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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30
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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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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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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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Babington EA. Complicated appendicitis in an adult patient. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:333-337. [PMID: 36969532 PMCID: PMC10034650 DOI: 10.1177/1742271x221093727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/22/2022] [Indexed: 11/15/2022]
Abstract
Introduction Appendicitis is a common cause for emergency operations in the western part of the world, mostly affecting children and young adults. Ultrasound in well-trained hands is an effective imaging tool in making this diagnosis; however, this does not come without its challenges and potential complications. Case report This is a case of a 19-year-old male with one-day history of severe pain in the right iliac fossa; blood results showed raised inflammatory markers. Ultrasound revealed a large abnormal loop of bowel containing heterogeneously echogenic contents, and two large appendicoliths at the base and fundus, with the presence of free fluid in the right iliac fossa and oedema in the adjacent mesentery. Laparoscopic appendectomy confirmed the presence of severe appendicitis with generalised peritonitis and appendicolith. Histology revealed gangrenous appendicitis with perforation in two places. Discussion This case demonstrates that making a diagnosis of an inflamed appendix alone on ultrasound is not enough, and conducting a detailed assessment of the inflamed appendix and its surrounding anatomy is essential so that all the associated findings can be reported to aid in the patient management, reduce hospital stay and improve overall diagnosis and prognosis.
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Muacevic A, Adler JR, Almuhaymidi R, Al-Hojailan AA, Alharbi AZ, Alolayan SS, Alqarzaee RS, Algosair I. Impacts of COVID-19 on Patients With Common Surgical Emergencies at the King Fahad Specialist Hospital in Buraidah, Saudi Arabia. Cureus 2022; 14:e31868. [PMID: 36579249 PMCID: PMC9792327 DOI: 10.7759/cureus.31868] [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: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is a global disaster with millions of infections and deaths. Healthcare systems and services were significantly affected, necessitating adjustments. These included postponement of scheduled appointments and elective surgeries. During the pandemic, there was an increase in the number of acute appendicitis, gallstones, and hernia with a significant impact on the signs and symptoms of presenting problems due to prehospital delay. AIM This study aims to measure the impacts of COVID-19 on patients with common surgical emergencies in King Fahad Specialist Hospital, Buraidah, Saudi Arabia. METHODS This is a single-center retrospective study conducted at King Fahad Specialist Hospital in Buraidah, Saudi Arabia. We reviewed all medical records of patients diagnosed with common surgical emergencies (acute appendicitis, gallstones, and hernia) during a selected time of COVID-19 lockdown and compared it with a similar set period before the crisis as a control sample. All medical records were reviewed to find out the overall number of admissions, frequency of emergency department (ED) visits, duration of illness, picture of clinical presentation, intraoperative findings, course and duration of admission, and final pathology if any. RESULTS A total of 322 patients were included in the study. Of these, 119 (37%) patients underwent surgery before COVID-19 while 203 (63%) patients underwent surgery during the pandemic. The diagnosis of acute appendicitis was 63.9% and 47.7%, hernia 27.7% and 34.6%, and gallstone was 8.4% and 17.7% for control and pandemic periods, respectively. The duration varied from 10 hours to two days and four hours to one month, seven hours to one day to eight hours to six months, and two hours to one day to seven hours to one and half a month for acute appendicitis, hernia, and gallstone in control and pandemic period, respectively. The mean length of stay for acute appendicitis was reduced from two days during the control period to one day during the pandemic period, from four to three days for gallstone, and for hernia, it remained three days for both the control and pandemic periods, respectively. Regarding the course of admission for acute appendicitis, the uneventful cases were reduced while an increase in uneventful cases for both hernia and gallstone was observed. CONCLUSION During the COVID-19 pandemic, there was a noticeable reduction in hospital visits. We observed an increase in the number of one-time visits and a reduction of three, four, and seven-time visits, which was attributed to the fact that patients have been reported to visit the hospital after a long time from the onset of symptoms with a higher chance of complication and subsequent surgeries. The number of acute appendicitis cases was reduced while the cases of hernia and gallstones increased significantly. The minimum period for the duration of acute illness for appendicitis was reduced in the pandemic period, while the minimum period for both gallstone and hernia was increased as both conditions could require conservative management. The mean length of hospital stay was reduced during the pandemic period, mainly due to the early discharge implemented in COVID-19 protocols to decrease the risk of infection. The severity of symptoms was increased due to the cancellation and delaying of surgeries.
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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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Sayyadi S, Ahmadinejad M, Mardi P, Rezae MM, Jafarabady K, Bahri MH, Bagherpour JZ. Accessory spleen presenting with an episode of acute appendicitis; a case report of a very rare case. Int J Surg Case Rep 2022; 99:107632. [PMID: 36126460 PMCID: PMC9568736 DOI: 10.1016/j.ijscr.2022.107632] [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: 07/29/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction The accessory spleen (AS) is a condition that results from improper placement of spleen cells. About 95 % of ASs are located in the splenic hilum proximal to the tail of the pancreas. Here we present a 23-year-old male diagnosed with AS in the appendix, following an episode of acute appendicitis. Case presentation A 23-year-old male patient who presented with typical symptoms of appendicitis and the examination and paraclinical findings were in favor of appendicitis. Intraoperative findings showed an inflamed appendix and a 2 cm solid mass in the mesoappendix. The pathology report showed acute appendicitis and normal spleen tissue. Conclusion The current study indicated an abnormal location of AS placed in the mesoappendix, which was presented with an episode of acute appendicitis. The accessory spleen (AS) is a condition that results from improper placement of spleen cells. About 95% of ASs are located in the splenic hilum proximal to the tail of the pancreas. The remaining 5% are formed in the gastrosplenic ligament, wall of the stomach, wall of the intestine, and the mesentery or pelvic cavity The current study indicated an abnormal location of AS placed in the mesoappendix, which was presented with an episode of acute appendicitis
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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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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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Torbjörnsson E, Fagerdahl AM, Älgå A. Experiences of Acute Surgical Care During the Coronavirus Disease 2019 Pandemic Among Patients and Their Next of Kin. J Surg Res 2022; 277:163-170. [PMID: 35490605 PMCID: PMC9005363 DOI: 10.1016/j.jss.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/10/2022] [Accepted: 04/05/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Since March 2020, the coronavirus disease 2019 pandemic has affected healthcare systems worldwide. It is largely unknown how acutely ill surgical patients and their next of kin have perceived the hospital care during the ongoing pandemic. Therefore, we aimed to explore their experiences. MATERIAL AND METHODS We performed 12 interviews with patients who had undergone acute abdominal surgery in a public acute care hospital in Sweden during March to June 2020. In addition, we interviewed 10 of the patients' next of kin. We analyzed the interviews using content analysis. RESULTS Our analysis resulted in two themes: "Worries about seeking acute care" and "The surgical care worked adequately, even though the system was overloaded." The participants experienced that the hospital maintained its functionality during the ongoing pandemic. Both the patients and their next of kin experienced insufficient information by the hospital, especially during the initial acute phase and at discharge, which led to a perceived loss of control. The implemented ban on visitors was found to have had both positive and negative effects for the patients, whereas the next of kin's experiences focused on the difficulties with not being able to visit. CONCLUSIONS Our findings indicate that the challenges of communication with patients and their next of kin are exacerbated during a crisis such as a pandemic. In addition, a ban on visitors might have both positive and negative aspects. Therefore, we propose individualized routines for visits to acute surgical patients when possible.
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Affiliation(s)
- Eva Torbjörnsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden,Corresponding author. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden. Tel.: +46 733 544 335; fax: + 46 8 616 2460
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Wound Centre, Södersjukhuset, Stockholm, Sweden
| | - Andreas Älgå
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Department of Surgery, Södersjukhuset, Stockholm, Sweden
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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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Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study. J Pediatr Surg 2022:S0022-3468(22)00512-7. [PMID: 36075771 PMCID: PMC9374489 DOI: 10.1016/j.jpedsurg.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/22/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes. METHODS A multicenter retrospective study was performed including 19 children's hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis. Groups were defined by each hospital's city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed. RESULTS Of 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More patients were managed non-operatively during the COVID-19 pandemic compared to before the pandemic (147 (6.1%) vs 144 (4.0%), p < 0.001). Despite this change, there was no difference in the proportion of complicated appendicitis between groups (1,247 (34.6%) vs 849 (35.2%), p = 0.12). COVID era non-operative patients received fewer additional procedures, including interventional radiology (IR) drain placements, compared to pre-COVID non-operative patients (29 (19.7%) vs 69 (47.9%), p < 0.001). On adjusted analysis, factors associated with increased odds of receiving non-operative management included: increasing duration of symptoms (OR=1.01, 95% CI: 1.01-1.012), African American race (OR=2.4, 95% CI: 1.3-4.6), and testing positive for COVID-19 (OR=10.8, 95% CI: 5.4-21.6). CONCLUSION Non-operative management of appendicitis increased during the COVID-19 pandemic. Additionally, fewer COVID era cases required IR procedures. These changes in the management of pediatric appendicitis during the COVID pandemic demonstrates the potential for future utilization of non-operative management.
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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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Ernudd I, Älgå A, Sandblom G, Dahlberg M, Mantel Ä. Treatment strategies and perforation rate of acute appendicitis during the early phase of the Covid-19 Pandemic: A Swedish cohort study. J Surg Res 2022; 280:450-458. [PMID: 36054956 PMCID: PMC9283669 DOI: 10.1016/j.jss.2022.07.007] [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: 02/23/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023]
Abstract
Introduction It is unknown whether the COVID-19 pandemic has had an impact on emergency surgical care in Sweden. This study aimed to compare frequency, treatment strategies, severity, and complication rate of appendicitis during the initial phase of the COVID-19 pandemic with those of previous years. Methods In this single-center study, we identified all patients admitted with appendicitis between March 16 and June 16, 2020, at the Stockholm South General Hospital, and compared these with patients hospitalized with appendicitis during the same calendar period the three previous years. We used multivariate logistic regression to calculate Odds Ratios (OR) with 95% confidence intervals as measurement of the association between appendicitis treatment and perforation rate during the COVID-19 period compared to the nonCOVID-19 periods. Results In all, 892 patients hospitalized with appendicitis were identified, 241 (27%) in 2020 (Covid period group) and the remaining 651 (73%) during the same calendar periods 2017-2019 (nonCovid period group). Appendicitis during the COVID-19 period was associated with double the risk for undergoing conservative treatment (OR 2.15 [95% CI 1.44-3.21]), and a decreased risk for being diagnosed with perforated appendicitis (OR 0.68 [95% CI 0.48-0.98]). Conclusions Patients admitted with appendicitis during the early phase of the COVID-19 pandemic in Stockholm, Sweden, were more likely to receive conservative treatment and less likely to suffer from perforated appendicitis compared to patients hospitalized before the pandemic. Hypothetically, this difference could have been due to pandemic-associated resource reallocation, or it may simply reflect an increasing trend towards conservative management of appendicitis.
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Affiliation(s)
- Ivan Ernudd
- Surgical Department, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
| | - Andreas Älgå
- Surgical Department, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Gabriel Sandblom
- Surgical Department, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Martin Dahlberg
- Surgical Department, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Ängla Mantel
- Department of Medicine, Solna, Sweden; Division of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden
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Hegde BN, Slater BJ. Long-Term Effect of the COVID-19 Pandemic on the Management of Pediatric Appendicitis. Pediatr Ann 2022; 51:e266-e269. [PMID: 35858217 DOI: 10.3928/19382359-20220504-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Appendicitis remains a common disease entity in pediatric patients that has historically been treated surgically with appendectomy as the standard of care. The coronavirus disease 2019 (COVID-19) pandemic introduced widespread challenges impacting the management and treatment of various disease processes, including pediatric appendicitis. Many studies demonstrated a decreased incidence in pediatric appendicitis cases, which may be attributable to fears of contracting the COVID-19 virus and restrictions imposed with stay-at-home orders. Many studies have noted both an increase in nonoperative management of pediatric appendicitis and a rise in patients presenting with complicated appendicitis. Additionally, the development of multisystem inflammatory syndrome in children that may present with symptoms mimicking appendicitis has created a diagnostic dilemma for pediatric care providers. Understanding the natural history of pediatric appendicitis during the COVID-19 pandemic and additional diagnostic and treatment difficulties are essential to ensure accurate care of pediatric patients that present with abdominal pain concerning for appendicitis. [Pediatr Ann. 2022;51(7):e266-e269.].
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Utku Çelik S, Lapsekili E, Alakuş Ü. Impact of the COVID-19 pandemic on emergency general surgery outcomes: A single-center retrospective cohort study. ULUS TRAVMA ACIL CER 2022; 28:900-910. [PMID: 35775682 PMCID: PMC10493828 DOI: 10.14744/tjtes.2021.89287] [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: 03/23/2021] [Accepted: 05/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The COVID-19 pandemic has affected the health-care system unpredictably. Restrictions and precautions have had a significant impact on the volume and nature of admissions in emergency services. In this study, we hypothesized that the pandemic would result in a change in the number of emergencies admitted to the general surgery inpatient service and a worse patient outcome compared to the previous year. METHODS A retrospective analysis of emergency general surgical admissions during the first 6 months of the pandemic and the same period in 2019 was conducted. Demographics, laboratory assessments, diagnosis, treatment strategies, and postoperative out-comes were analyzed. RESULTS 761 patients were admitted to the general surgery service during two 6-month periods (392 vs. 369, respectively). This represented a 5.9% reduction in admissions. However, in the first 2 months of the pandemic, the number of emergency general surgical admissions decreased by 37.1% and 43.7%, respectively. Comparison of periods demonstrated no significant differences in demograph-ics, laboratory values, incidence of emergencies, treatment strategies, and hospital stay. Acute appendicitis, cholecystitis, and bowel obstruction were the three most common surgical emergencies in the pandemic. However, there was no significant difference in outcomes between the periods when each surgical emergency was evaluated separately. CONCLUSION Pandemic appears to affect general surgical admissions with a fluctuating pattern, an increasing trend following a sig-nificant 2-month decrease. These findings suggest that patients presented with a delayed presentation; however, contrary to concerns, there was no difference in patient outcomes between the two periods. This study provides a perspective in management strategies for surgical emergencies in such unusual conditions.
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Affiliation(s)
- Süleyman Utku Çelik
- Department of General Surgery, Health Science University, Gülhane Training and Research Hospital, Ankara-Türkiye
| | - Emin Lapsekili
- Department of General Surgery, Health Science University, Gülhane Training and Research Hospital, Ankara-Türkiye
| | - Ümit Alakuş
- Division of Gastroenterological Surgery, Department of General Surgery, Health Science University, Gülhane Training and Research Hospital, Ankara-Türkiye
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Alotaibi AM, Alfawaz M, Felemban L, Moshref L, Moshref R. Complicated appendicitis increases the hospital length of stay. Surg Open Sci 2022; 9:64-68. [PMID: 35692621 PMCID: PMC9178463 DOI: 10.1016/j.sopen.2022.05.006] [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: 04/05/2022] [Revised: 04/27/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background There are insufficient data from Saudi Arabia regarding appendectomy outcomes and hospital length of stay. Further, there is a need to compare the length of stay of Saudi patients and the literature. The purpose is to evaluate the surgical outcomes and hospital length of stay for complicated appendicitis and simple appendicitis. Method This is a single-center retrospective review of patients who had undergone an appendectomy between 2016 and 2018. The patients were divided into 2 groups: complicated appendicitis versus simple appendicitis. Results Of 449 patients who underwent appendectomy, 60 (13.4%) had complicated appendicitis. The complicated appendicitis was significantly associated with increased age, pain duration, neutrophilia, high C-reactive protein, fecalith presence, and free fluid. The incidence rate of surgical site infection was 5.8% (identified in 26 patients). Compared to simple appendicitis, complicated appendicitis was associated more with wound infection (1.8% vs 10%, respectively, P = .001), postoperative collection (1.2% vs 11.6%, respectively, P = .001), and readmission within 30 days (2.3% vs 13.4%, respectively, P = .001). By multivariate analysis, factors associated more with increased hospitalization were pain duration (hazard ratio = 2.37, 95% confidence interval = 1.09–5.16, P = .029), operative time (hazard ratio = 2.09, 95% confidence interval = 1.04–4.21, P = .038), and complicated appendicitis (hazard ratio = 6.61, 95% confidence interval = 2.67–14.21, P = .001). Conclusion Complicated appendicitis correlates with significant morbidity, readmission rate, and 6 times more hospital LOS than simple appendicitis. This review might help in appreciating the burden of complicated appendicitis on hospital length of stay, which needs allocating patients and planning the discharge day for hospitals with limited beds. Practically one fifth of acute appendicitis will be complicated. Complicated appendicitis increases conversion to open, surgical site infection, hospital length of stay, and 30-day readmission rate. Prolonged operation time and complicated appendicitis are independent risk factors to increase hospitalization.
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Affiliation(s)
- Abdulrahman Muaod Alotaibi
- Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
- Department of Surgery, Dr Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
- Corresponding author at: Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia. Office contact number: 00966 0122334444, mobile contact no. + 966 504707351. @aotaib1
| | - Mohammed Alfawaz
- Department of Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Lina Felemban
- Department of Surgery, King Abdul-Aziz Medical City, National Guard Hospital, Jeddah, Saudi Arabia
| | - Leena Moshref
- Department of Surgery, Dr Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Rana Moshref
- Department of Surgery, Dr Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
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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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