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Mudarra Vela AM, Rivas Ruiz F, Atienza Carrasco J, Medina Cano FJ. Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2023; 88:354-360. [PMID: 35810102 PMCID: PMC9192794 DOI: 10.1016/j.rgmxen.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIMS Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. MATERIALS AND METHODS A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. RESULTS The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6 [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. CONCLUSIONS During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.
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Affiliation(s)
- A M Mudarra Vela
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain.
| | - F Rivas Ruiz
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain; Red de investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - J Atienza Carrasco
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain
| | - F J Medina Cano
- Agencia Pública Empresarial Sanitaria Costa del Sol, Marbella, Málaga, Spain; Red de investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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Choi YS, Yi JW, Chung CTY, Shin WY, Choi SK, Heo YS. Clinical Experience of Emergency Appendectomy under the COVID-19 Pandemic in a Single Institution in South Korea. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060783. [PMID: 35744046 PMCID: PMC9230818 DOI: 10.3390/medicina58060783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The COVID-19 pandemic has brought serious changes in healthcare systems worldwide, some of which have affected patients who need emergency surgery. Acute appendicitis is the most common surgical disease requiring emergency surgery. This study was performed to determine how the COVID-19 pandemic has changed the treatment of patients with acute appendicitis in South Korea. Materials and Methods: We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis in our hospital from January 2019 to May 2021. We classified the patients into two groups according to whether they were treated before or after the COVID pandemic and 10 March 2020 was used as the cutoff date, which is when the World Health Organization declared the COVID pandemic. Results: A total of 444 patients were included in the “Pre-COVID-19” group and 393 patients were included in the “COVID-19” group. In the “COVID-19” group, the proportion of patients with severe morbidity was significantly lower. The time that the patients spent in the emergency room before surgery was significantly longer in the ”COVID-19” group (519.11 ± 486.57 min vs. 705.27 ± 512.59 min; p-value < 0.001). There was no difference observed in the severity of appendicitis or in the extent of surgery between the two groups. Conclusions: During the COVID-19 pandemic, a statistically significant time delay (186.16 min) was needed to confirm COVID-19 infection status. However, there was no clinical difference in the severity of appendicitis or in the extent of surgery. To ensure the safety of patients and medical staff, a COVID-19 PCR test should be performed.
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Grossi U, Gallo G, Ortenzi M, Piccino M, Salimian N, Guerrieri M, Sammarco G, Felice C, Santoro GA, Di Saverio S, Di Tanna GL, Zanus G. Changes in hospital admissions and complications of acute appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis. HEALTH SCIENCES REVIEW (OXFORD, ENGLAND) 2022; 3:100021. [PMID: 35287332 PMCID: PMC8906891 DOI: 10.1016/j.hsr.2022.100021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/29/2022]
Abstract
Background Acute appendicitis (AA) is one of the most common emergencies in general surgery worldwide. During the pandemic, a significant decrease in the number of accesses to the emergency department for AA has been recorded in different countries. A systematic review of the current literature sought to determine the impact of Coronavirus Disease 2019 (COVID-19) on hospital admissions and complications of AA. Method A systematic search was undertaken to identify repeated cross-sectional studies reporting the management of AA during the COVID-19 pandemic (index period) as compared to the previous year, or at the turn of lockdown (reference period). Data were abstracted on article (country of origin) and patients characteristics (adults, children [i.e. non adults, <18-year-old]), or mixed population) within the two given timeframes, including demographics, number of admissions for AA, number of appendectomies, and complicated appendectomies. Results Of 201 full-text articles assessed for eligibility, 54 studies from 22 world countries were included. In total, 27 (50%) were conducted on adults, 12 (22%) on children, and 15 (28%) on a mixed patients population. The overall rate ratio of admissions for AA between the two periods was 0.94 (95%CI, 0.75-1.17), with significant differences between studies on adults (0.90 [0.74-1.09]), mixed population (0.50 [0.27-0.90]), and children (1.50 [1.01-2.22]). The overall risk ratio of complicated AA was 1.65 (1.32-2.07), ranging from 1.32 in studies on children, to 2.45 in mixed population. Conclusion The pandemic has altered the rate of admissions for AA and appendectomy, with parallel increased incidence of complicated cases in all age groups.
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Affiliation(s)
- Ugo Grossi
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Marco Piccino
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Nick Salimian
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Giuseppe Sammarco
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Carla Felice
- I Medicine Unit, Treviso Regional Hospital, DIMED, University of Padua, Italy
| | | | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Giacomo Zanus
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
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Mudarra Vela M, Rivas Ruiz F, Atienza Carrasco J, Medina Cano FJ. [Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area]. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2022; 88:S0375-0906(22)00046-5. [PMID: 35528028 PMCID: PMC9058025 DOI: 10.1016/j.rgmx.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIMS Gastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. MATERIALS AND METHODS A retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. RESULTS The study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6, [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. CONCLUSIONS During the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.
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Affiliation(s)
- M Mudarra Vela
- Agencia Pública Empresarial Sanitaria Costa del Sol. Marbella, Málaga, España
| | - F Rivas Ruiz
- Agencia Pública Empresarial Sanitaria Costa del Sol. Marbella, Málaga, España
- Red de investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España
| | - J Atienza Carrasco
- Agencia Pública Empresarial Sanitaria Costa del Sol. Marbella, Málaga, España
| | - F J Medina Cano
- Agencia Pública Empresarial Sanitaria Costa del Sol. Marbella, Málaga, España
- Red de investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España
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Pogorelić Z, Anand S, Žuvela T, Singh A, Križanac Z, Krishnan N. Incidence of Complicated Appendicitis during the COVID-19 Pandemic versus the Pre-Pandemic Period: A Systematic Review and Meta-Analysis of 2782 Pediatric Appendectomies. Diagnostics (Basel) 2022; 12:127. [PMID: 35054293 PMCID: PMC8774400 DOI: 10.3390/diagnostics12010127] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic has impacted volume, management strategies and patient outcomes of acute appendicitis. The aim of this systematic review and meta-analysis was to evaluate whether the COVID-19 pandemic resulted in higher incidence of complicated appendicitis in children presenting with acute appendicitis compared to the pre-COVID-19 period. The secondary aim was to investigate the proportion of the patients treated by non-operative management (NOM). METHODS A systematic search of four scientific databases was performed. The search terms used were (coronavirus OR SARS-CoV-2 OR COVID-19 OR novel coronavirus) AND (appendicitis). The inclusion criteria were all patients aged <18 years and diagnosed with acute appendicitis during the COVID-19 and pre-COVID-19 periods. The proportion of children presenting with complicated appendicitis and the proportion of children managed by NOM was compared between the two groups. The Downs and Black scale was used for methodological quality assessment. RESULTS The present meta-analysis included thirteen studies (twelve retrospective studies and one cross-sectional study). A total of 2782 patients (1239 during the COVID-19 period) were included. A significantly higher incidence of complicated appendicitis (RR = 1.63, 95% CI 1.33-2.01, p < 0.00001) and a significantly higher proportion of children managed via the NOM (RR = 1.95, 95% CI 1.45-2.61, p < 0.00001) was observed in patients during the COVID-19 pandemic when compared to the pre-COVID-19 period. CONCLUSION There is a significantly higher incidence of complicated appendicitis in children during the COVID-19 pandemic than in the pre-COVID-19 period. Additionally, a significantly higher proportion of children was managed via the NOM during the pandemic in comparison to the pre-pandemic period.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, 21 000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, 21 000 Split, Croatia;
| | - Sachit Anand
- Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai 400053, India;
| | - Tomislav Žuvela
- Department of Surgery, School of Medicine, University of Split, 21 000 Split, Croatia;
| | - Apoorv Singh
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India; (A.S.); (N.K.)
| | - Zvonimir Križanac
- Department of Surgery, University Hospital of Split, 21 000 Split, Croatia;
| | - Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India; (A.S.); (N.K.)
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Bašković M, Čizmić A, Bastić M, Župančić B. The Impact of the COVID-19 Pandemic on the Most Common Diagnoses in Pediatric Surgery: Abdominal Pain, Acute Scrotum, Upper and Lower Extremity Injuries-Tertiary Center Experience. Turk Arch Pediatr 2022; 57. [PMID: 35110077 PMCID: PMC8867514 DOI: 10.5152/turkarchpediatr.2021.21230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The coronavirus disease-19 pandemic has brought new patterns of behavior among patients and their parents. The reorganization of the health care system has reduced the number of elective surgical procedures in Croatia. In our study, we were interested in whether the pandemic has caused a statistically significant decrease in the number of examinations of children in the emergency department according to the most common diagnoses in pediatric surgery and whether there was a decrease in the number of emergency surgeries. MATERIALS AND METHODS We retrospectively analyzed data from the Hospital Information System. The analysis included 15 months of the pre-coronavirus disease-19 period and 15 months of the coronavirus disease-19 period. The primary outcome of the study was to determine the cumulative number of all examinations and then to determine the number of examinations according to the most common diagnoses and, consequently, to determine whether there was a statistically significant decrease. The secondary outcome was to determine the cumulative number of all operations and then to determine the number of the most common emergency operations and, consequently, to see if there was a statistically significant decrease. RESULTS In the 15 months of the pre- coronavirus disease-19 period, a total of 33 646 children were examined in the emergency department, while in the coronavirus disease-19 period, 26 831 were examined (P = .010). Although a decrease was recorded in all categories, a statistically significant decrease was recorded for diagnoses of abdominal pain (P = .007) and lower extremity injuries (P = .014). The total number of operations, due to strict measures and reduction of the elective program, decreased statistically significantly in the coronavirus disease-19 period (P < .0001). The number of most common emergency operations did not decrease statistically significantly. CONCLUSION This study represents the first longer, 15-month experience of a pandemic in the only and largest children's hospital in Croatia. There is no doubt that coronavirus disease-19 had the effect of reducing the number of examinations in the emergency department for all the most common diagnoses, but the number of operations did not change significantly.
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Abstract
Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.
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Affiliation(s)
- Richard Taylor
- Pediatric Residency Program, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 5018, Cincinnati, OH 45229, USA
| | - Daniel Mallon
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2010, Cincinnati, OH 45229, USA.
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