1
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Johnston DB, Coleman HG, Colvin D, Lawther S, Loughrey MB. Impact of COVID-19 on acute appendicitis presentation, management and pathology findings in adult and paediatric populations. PLoS One 2024; 19:e0300357. [PMID: 38630774 PMCID: PMC11023581 DOI: 10.1371/journal.pone.0300357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND We investigated the impact of the COVID-19 pandemic on trends of presentation, management and pathology findings in patients who underwent an appendicectomy for suspected acute appendicitis. METHOD The retrospective study reviewed patients (n = 939 adults and n = 329 children) who had an appendicectomy performed for suspected acute appendicitis and histopathology assessment in the Belfast Health and Social Care Trust, Northern Ireland. Pre-COVID-19 (March 2019 to February 2020) and COVID-19 Year 1 (March 2020 to February 2021) data were compared. Chi-squared tests were applied to compare timeframes. RESULTS 513 adult appendicectomies were performed in the immediate year pre-COVID-19, compared to 426 in COVID-19 Year 1, representing a 17% reduction. No such reduction was seen within the paediatric population, likely related to a change in regional paediatric referral criteria during the pandemic. When comparing COVID-19 Year 1 with pre-pandemic, fewer patients presented with <24 hours of symptoms (45% v 53%, p = 0.005), and there was greater use of pre-operative computed tomography imaging in adults (63.2% v 48.7%, p<0.001). Fewer adult and paediatric cases of simple acute appendicitis and non-diagnostic specimens, with relative increased proportions of perforated acute appendicitis, were observed in COVID-19 Year 1 compared with pre-pandemic. No absolute increase in perforated acute appendicitis cases was observed in adults. CONCLUSION Year 1 of the COVID-19 pandemic was associated with delayed presentation of acute appendicitis in adults and children. In adults, an overall reduction in appendicectomy operations, increased use of pre-operative diagnostic imaging, and fewer specimens showing simple acute appendicitis or non-diagnostic features, collectively support appropriate restriction of surgery for those patients with a more certain acute appendicitis diagnosis.
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Affiliation(s)
- Dorothy B. Johnston
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Helen G. Coleman
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - David Colvin
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Suzanne Lawther
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Maurice B. Loughrey
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
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2
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Pantalos G, Papachristidou S, Mavrigiannaki E, Zavras N, Vaos G. Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review. Diagnostics (Basel) 2023; 13:2571. [PMID: 37568934 PMCID: PMC10417690 DOI: 10.3390/diagnostics13152571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Global pandemics cause health system disruptions. The inadvertent disruption in surgical emergency care during the Coronavirus Disease 2019 (COVID-19) pandemic has been the topic of several published studies. Our aim was to summarize the reasons that led to the delayed diagnosis of pediatric appendicitis during the COVID-19 era. This systematic literature search evaluated studies containing pediatric appendicitis patient data regarding outcomes, times to hospital admission or times from symptom onset to emergency department visit. Studies elucidating reasons for delays in the management of pediatric appendicitis were also reviewed. Ultimately, 42 studies were included. Several reasons for delayed diagnosis are analyzed such as changes to public health measures, fear of exposure to COVID-19, increased use of telemedicine, COVID-19 infection with concurrent acute appendicitis, recurrence of appendicitis after non-operative management and increased time to intraoperative diagnosis. Time to hospital admission in conjunction with patient outcomes was extracted and analyzed as an indicative measure of delayed management. Delayed diagnosis of acute appendicitis has been documented in many studies with various effects on outcomes. Suspicion of pediatric acute appendicitis must always lead to prompt medical examination, regardless of pandemic status. Telemedicine can be valuable if properly applied. Data from this era can guide future health system policies.
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Affiliation(s)
- George Pantalos
- Pediatric Intensive Care Unit, Penteli General Children’s Hospital, 15236 Athens, Greece
| | - Smaragda Papachristidou
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, P. & A. Kyriakou Children’s Hospital, 11527 Athens, Greece;
| | - Eleftheria Mavrigiannaki
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
| | - Nikolaos Zavras
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
| | - George Vaos
- Department of Pediatric Surgery, School of Medicine, National and Kapodistrian University of Athens, “Attikon” General University Hospital, 12462 Athens, Greece; (E.M.); (G.V.)
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3
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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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4
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Nguyen HV, Tran LH, Ly TH, Pham QT, Pham VQ, Tran HN, Trinh LT, Dinh TT, Pham DT, Mai Phan TA. Impact of the COVID-19 Pandemic on the Severity and Early Postoperative Outcomes of Acute Appendicitis. Cureus 2023; 15:e42923. [PMID: 37546691 PMCID: PMC10400342 DOI: 10.7759/cureus.42923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic caused changes in surgical practice. For acute appendicitis (AA), measures to control the pandemic might hinder patients from seeking medical care timely, resulting in increasing severity, postoperative complications, and mortality. This study aimed to investigate whether the COVID-19 pandemic had a negative impact on the severity and postoperative outcomes of patients with AA. Methodology We retrospectively reviewed medical records of AA patients treated operatively at Nhan Dan Gia Dinh Hospital hospital from June 1st to September 30th in three consecutive years: pre-pandemic (2019)/Group 1, minor waves (2020)/Group 2, and major wave (2021)/Group 3 (2021). Data were collected focusing on the duration of symptoms, severity of AA, time from admission to operation, postoperative complications, and mortality. Results There were 1,055 patients, including 452 patients in Group 1, 409 in Group 2, and 194 in Group 3. The overall number of patients decreased mainly in non-complicated AA. The percentages of hospital admission after 24 hours gradually increased (20.8%, 27.9%, and 43.8%, p < 0.05). The percentages of complicated AA in Group 2 and Group 3 were statistically higher than in Group 1 (39% and 55% vs. 31%, p < 0.05). Waiting time for operation increased to five hours during the major wave. Laparoscopic appendectomy was performed in 98-99% of AA patients during the pandemic, with an early postoperative complication rate of 5-9% and a mortality rate of 0.2-1%. Conclusions Although the percentages of hospital admission after 24 hours and complicated AA increased, laparoscopic appendectomy was still feasible and effective and should be maintained as the standard management for AA during the COVID-19 pandemic.
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Affiliation(s)
- Hai V Nguyen
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Loc H Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Tuan H Ly
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Quang T Pham
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, VNM
| | - Vu Q Pham
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Ha N Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Loc T Trinh
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Thien T Dinh
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Dinh T Pham
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Tuong Anh Mai Phan
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
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5
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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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6
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Hatami D, Alavi SMA. Complicated appendicitis, acute pancreatitis, pleural effusion, and sinus bradycardia in a COVID-19 patient. Clin Case Rep 2023; 11:e7077. [PMID: 36911648 PMCID: PMC9995805 DOI: 10.1002/ccr3.7077] [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: 01/30/2023] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023] Open
Abstract
This study shows that complicated appendicitis and acute pancreatitis could occur during a COVID-19 infection, since the same gastrointestinal manifestations are notable in all aforementioned diseases. Sinus bradycardia is a side effect of remdesivir. Both COVID-19 infection and remdesivir therapy can elevate liver transaminases.
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Affiliation(s)
- Danial Hatami
- Faculty of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
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7
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Winicki NM, Dahan A, Maheshwari S, Crowley B, Gelbard R, Burruss S. Racial and ethnic variation in emergent surgical care and outcomes during the COVID-19 pandemic: post hoc analysis of an EAST MCT. Trauma Surg Acute Care Open 2022; 7:e001023. [PMID: 36532692 PMCID: PMC9742842 DOI: 10.1136/tsaco-2022-001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives The COVID-19 pandemic highlighted concerns regarding the equity of medical care. We evaluated associations between race/ethnicity, timing of hospital presentation and outcomes of acute appendicitis (AP) and acute cholecystitis (AC) during the initial pandemic peak. Methods Analysis was performed on a prospective, observational, multicenter study of adults with AP or AC. Patients were categorized as pre-pandemic (pre-CoV: October 2019–January 2020) or during the first pandemic peak (CoV: April 2020 through 4 months following the end of local pandemic restrictions). Patient demographics, American Association for the Surgery of Trauma (AAST) imaging/pathology grade, duration of symptoms before triage, time from triage to intervention and hospital length of stay were collected. Results A total of 2165 patients (1496 pre-CoV, 669 CoV) were included from 19 centers. Asian and Hispanic patients with AC had a longer duration of symptoms prior to presentation during CoV than pre-CoV (100.6 hours vs 37.5 hours, p<0.01 and 85.7 hours vs 52.5 hours, p<0.05, respectively) and presented later during CoV than Black or White patients (34.3 and 37.9 hours, p<0.01). During CoV, Asian patients presented with higher AAST pathology grade for AP compared with pre-CoV (1.90 vs 1.26, p<0.01). Asian and Hispanic patients presented with higher AAST pathology grade for AC during CoV versus pre-CoV (2.57 vs 1.45, p<0.01, and 1.57 vs 1.20, p<0.05, respectively). Patients with AC and an AAST pathology grade of ≥3 were at higher odds of postoperative complications (OR 4.4, 95% CI 1.0 to 18.4) and AP (OR 2.8, 95% CI 1.3 to 6.0). Asian and Hispanic patients with AC had a higher risk of postoperative complications compared to White patients (Asian: OR 3.9, 95% CI 1.2 to 12.7; Hispanic: OR 3.3, 95% CI 1.2 to 8.9). Conclusion Asian and Hispanic patients had a longer duration of symptoms before hospital presentation during the initial COVID-19 peak, had higher odds of postoperative complications and more advanced pathologic disease. Level of evidence III, Prognostic/epidemiological.
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Affiliation(s)
- Nolan M Winicki
- University of California Riverside School of Medicine, Riverside, California, USA,Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Alden Dahan
- University of California Riverside School of Medicine, Riverside, California, USA,Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Somiya Maheshwari
- University of California Riverside School of Medicine, Riverside, California, USA
| | - Brandon Crowley
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rondi Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
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8
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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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9
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Aulet TH, Spencer SB, Abelson JS, Breen EM, Kuhnen AH, Saraidaridis JT, Marcello PW, Kleiman DA. Impact of the first COVID-19 surge on the outcomes of diverticulitis. SURGERY IN PRACTICE AND SCIENCE 2022; 10:100116. [PMCID: PMC9316939 DOI: 10.1016/j.sipas.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 10/26/2022] Open
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10
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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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11
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van Amstel P, El Ghazzaoui A, Hall NJ, Wester T, Morini F, van der Lee JH, Singer G, Pierro A, Zani A, Gorter RR. Paediatric appendicitis: international study of management in the COVID-19 pandemic. Br J Surg 2022; 109:1044-1048. [PMID: 36240511 PMCID: PMC9384519 DOI: 10.1093/bjs/znac239] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/21/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Paul van Amstel
- Correspondence to: Paul van Amstel, Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (e-mail: )
| | - Ali El Ghazzaoui
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Tomas Wester
- Department of Paediatric Surgery, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Francesco Morini
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus, Newborn, and Infant, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Johanna H van der Lee
- Pediatric Clinical Research Office, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, the Netherlands
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Agostino Pierro
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Augusto Zani
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ramon R Gorter
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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12
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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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13
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Mogharab V, Ostovar M, Ruszkowski J, Hussain SZM, Shrestha R, Yaqoob U, Aryanpoor P, Nikkhoo AM, Heidari P, Jahromi AR, Rayatdoost E, Ali A, Javdani F, Farzaneh R, Ghanaatpisheh A, Habibzadeh SR, Foroughian M, Ahmadi SR, Akhavan R, Abbasi B, Shahi B, Hakemi A, Bolvardi E, Bagherian F, Motamed M, Boroujeni ST, Jamalnia S, Mangouri A, Paydar M, Mehrasa N, Shirali D, Sanmarchi F, Saeed A, Jafari NA, Babou A, Kalani N, Hatami N. Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses. Global Health 2022; 18:58. [PMID: 35676714 PMCID: PMC9175527 DOI: 10.1186/s12992-022-00836-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023] Open
Abstract
Background Apart from infecting a large number of people around the world and causing the death of many people, the COVID-19 pandemic seems to have changed the healthcare processes of other diseases by changing the allocation of health resources and changing people’s access or intention to healthcare systems. Objective To compare the incidence of endpoints marking delayed healthcare seeking in medical emergencies, before and during the pandemic. Methods Based on a PICO model, medical emergency conditions that need timely intervention was selected to be evaluated as separate panels. In a systematic literature review, PubMed was quarried for each panel for studies comparing the incidence of various medical emergencies before and during the COVID-19 pandemic. Markers of failure/disruption of treatment due to delayed referral were included in the meta-analysis for each panel. Result There was a statistically significant increased pooled median time of symptom onset to admission of the acute coronary syndrome (ACS) patients; an increased rate of vasospasm of aneurismal subarachnoid hemorrhage; and perforation rate in acute appendicitis; diabetic ketoacidosis presentation rate among Type 1 Diabetes Mellitus patients; and rate of orchiectomy among testicular torsion patients in comparison of pre-COVID-19 with COVID-19 cohorts; while there were no significant changes in the event rate of ruptured ectopic pregnancy and median time of symptom onset to admission in the cerebrovascular accident (CVA) patients. Conclusions COVID-19 has largely disrupted the referral of patients for emergency medical care and patient-related delayed care should be addressed as a major health threat. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00836-2.
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Affiliation(s)
- Vahid Mogharab
- Department of Pediatrics, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mahshid Ostovar
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Jakub Ruszkowski
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.,Department of Pathophysiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Rajeev Shrestha
- Palliative Care and Chronic Disease Unit, Green Pasteur Hospital, Pokhara, Nepal
| | - Uzair Yaqoob
- Postgraduate trainee, Surgical Department, Hamdard University Hospital Karachi, Karachi, Pakistan
| | - Poorya Aryanpoor
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Amir Mohammad Nikkhoo
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Parasta Heidari
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Athar Rasekh Jahromi
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Esmaeil Rayatdoost
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Anwar Ali
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Farshid Javdani
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Roohie Farzaneh
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aref Ghanaatpisheh
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Seyed Reza Habibzadeh
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Foroughian
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sayyed Reza Ahmadi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Akhavan
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Abbasi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
| | - Behzad Shahi
- Department of Emergency Medicine, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Arman Hakemi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Bolvardi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Bagherian
- Department of Emergency Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mahsa Motamed
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sheida Jamalnia
- Medical Journalism Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Mangouri
- Fellowship of Vascular Surgery and Endovascular Therapy, Division of Vascular Surgery and Endovascular Therapy, Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Paydar
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Neda Mehrasa
- Shiraz Azad University, Dental Branch, Shiraz, Iran
| | | | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Ayesha Saeed
- Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Narges Azari Jafari
- Neuroscience Research Department Center, Kashan University of Medical Science, Kashan, Iran
| | - Ali Babou
- Pharmaceutical Sciences Department, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Navid Kalani
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
| | - Naser Hatami
- Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
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14
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Kanamori D, Kurobe M, Sugihara T, Harada A, Kaji S, Uchida G, Baba Y, Ohashi S, Ashizuka S, Ohki T. Increase in pediatric complicated appendicitis during the COVID-19 pandemic: a multi-center retrospective study. Surg Today 2022; 52:1741-1745. [PMID: 35672523 PMCID: PMC9172983 DOI: 10.1007/s00595-022-02529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/30/2022] [Indexed: 11/06/2022]
Abstract
Purpose An increase in the incidence of pediatric complicated appendicitis (CA) during the COVID-19 pandemic has been reported in many countries. We investigated how the pandemic has affected Japan. Methods We retrospectively reviewed children of ≤ 15 years old treated for acute appendicitis across 5 medical centers during the pandemic period (January to October in 2020), with the pre-pandemic period (January to October in 2017 to 2019) evaluated as a historical control. The incidence of CA and disease characteristics were then compared between the periods. Results The total number of patients was 55 in 2020 and 192 in 2017–2019. In all centers, the incidence of acute pediatric CA in the pandemic period significantly increased compared to the pre-pandemic period (18.2% vs. 32.7%, p = 0.02). On limiting our evaluation to the 3 institutions with reductions in patient numbers, the incidence of CA increased (16.3% vs. 37.9%, p = 0.01), and the duration of pre-operative symptoms was prolonged (1.3% vs. 1.7 days, p = 0.03). There were no significant differences in the age, sex, white blood cell count, C-reactive protein, or body temperature. No cases were diagnosed with SARS-CoV-2. Conclusions The incidence of acute pediatric CA increased during the pandemic period. This may be related to an extended duration of symptoms due to individuals fearing contracting COVID-19 while visiting a hospital.
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Affiliation(s)
- Daisuke Kanamori
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Masashi Kurobe
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tetsuro Sugihara
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Atsushi Harada
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Sayuri Kaji
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Goki Uchida
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuji Baba
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shinsuke Ohashi
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shuichi Ashizuka
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takao Ohki
- Division of Pediatric Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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15
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Grossi U, Gallo G, Ortenzi M, Piccino M, Salimian N, Guerrieri M, Sammarco G, Felice C, Santoro GA, Di Saverio S, Di Tanna GL, Zanus G. Changes in hospital admissions and complications of acute appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis. HEALTH SCIENCES REVIEW (OXFORD, ENGLAND) 2022; 3:100021. [PMID: 35287332 PMCID: PMC8906891 DOI: 10.1016/j.hsr.2022.100021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/29/2022]
Abstract
Background Acute appendicitis (AA) is one of the most common emergencies in general surgery worldwide. During the pandemic, a significant decrease in the number of accesses to the emergency department for AA has been recorded in different countries. A systematic review of the current literature sought to determine the impact of Coronavirus Disease 2019 (COVID-19) on hospital admissions and complications of AA. Method A systematic search was undertaken to identify repeated cross-sectional studies reporting the management of AA during the COVID-19 pandemic (index period) as compared to the previous year, or at the turn of lockdown (reference period). Data were abstracted on article (country of origin) and patients characteristics (adults, children [i.e. non adults, <18-year-old]), or mixed population) within the two given timeframes, including demographics, number of admissions for AA, number of appendectomies, and complicated appendectomies. Results Of 201 full-text articles assessed for eligibility, 54 studies from 22 world countries were included. In total, 27 (50%) were conducted on adults, 12 (22%) on children, and 15 (28%) on a mixed patients population. The overall rate ratio of admissions for AA between the two periods was 0.94 (95%CI, 0.75-1.17), with significant differences between studies on adults (0.90 [0.74-1.09]), mixed population (0.50 [0.27-0.90]), and children (1.50 [1.01-2.22]). The overall risk ratio of complicated AA was 1.65 (1.32-2.07), ranging from 1.32 in studies on children, to 2.45 in mixed population. Conclusion The pandemic has altered the rate of admissions for AA and appendectomy, with parallel increased incidence of complicated cases in all age groups.
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Affiliation(s)
- Ugo Grossi
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy,Corresponding author at: National Bowel Research Centre, Queen Mary University of London, 2 Newark Street, London E1 2AT, United Kingdom
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Marco Piccino
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Nick Salimian
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Mario Guerrieri
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Giuseppe Sammarco
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - Carla Felice
- I Medicine Unit, Treviso Regional Hospital, DIMED, University of Padua, Italy
| | | | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, ASST Sette Laghi, Varese, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Giacomo Zanus
- II Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
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16
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Tamirian R, Klein M, Chui P, Park J, Frangos S, Shah P, Malino CM. Acute Appendicitis During The COVID-19 Pandemic: A Multicenter, Retrospective Analysis From The US Epicenter. Am Surg 2022:31348221103649. [PMID: 35599614 PMCID: PMC9124948 DOI: 10.1177/00031348221103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Acute appendicitis (AA) is the most common surgical emergency, with a relatively stable yearly incidence. During the first wave of the COVID-19 pandemic, as New York City (NYC) emerged as the US epicenter, hospitals saw a marked reduction in patients presenting with non-COVID-related diseases. The objective of this study was to characterize the effects of the pandemic on the incidence, presentation, and management of AA. Methods A retrospective analysis of patients with AA who presented to two academic medical centers during the NYC COVID peak (March 22nd-May 31st, 2020) was performed. This group was compared to a control cohort presenting during the same period in 2019. Primary outcomes included the incidence of AA, complicated disease, and management. Secondary outcomes included duration of symptoms, hospital length of stay, and complication rates. Statistical analyses were performed using Mann-Whitney U, Chi-square, and Fisher’s exact tests. Results A 49.1% reduction in the incidence of AA was seen between 2019 (n = 114) and 2020 (n = 58). Median duration of symptoms doubled from 1 day in 2019 to 2 days in 2020 (P < .02). Proportionally, the incidence of complicated appendicitis rose from 19.3% to 41.4% (P < .005). 32.4% of patients with uncomplicated AA underwent non-operative management in 2020, compared to 12% in 2019 (P < .02). Hospital length of stay and complication rates were similar between years. Discussion Significantly fewer AA patients presented during the initial phase of the pandemic. Patients presented later, which may have contributed to a higher proportion of complicated disease. Surgeons were also more likely to treat uncomplicated AA nonoperatively than they were prior. Further research is needed to understand the long-term consequences of these changes.
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Affiliation(s)
- Richard Tamirian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Richard Tamirian, Department of Surgery, NYU Grossman School of Medicine, 334 E. 26th Street New York, NY 10010, USA.
| | - Michael Klein
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Department of Surgery, New York City Health + Hospitals/Bellevue, New York, NY, USA
| | - Patricia Chui
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Department of Surgery, New York City Health + Hospitals/Bellevue, New York, NY, USA
| | - Julia Park
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Department of Surgery, New York City Health + Hospitals/Bellevue, New York, NY, USA
| | - Spiros Frangos
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
- Department of Surgery, New York City Health + Hospitals/Bellevue, New York, NY, USA
| | - Paresh Shah
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Cris M.K. Malino
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
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17
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Wu J, Jiang H, Li S, Wu X, Wang P, Sawyer R, Ren J. Optimising the treatment for uncomplicated acute appendicitis (OPTIMA trial): a protocol for a multicentre, randomised, double-blinded placebo-controlled study. BMJ Open 2022; 12:e057793. [PMID: 35501082 PMCID: PMC9062814 DOI: 10.1136/bmjopen-2021-057793] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Emerging evidence has shown that an antibiotic first strategy is a viable treatment option for uncomplicated acute appendicitis (AA). Although there has recently been an interest and increase in the use of antibiotics as the primary strategy for treating uncomplicated AA, there is no consensus regarding the optimum antibiotic regimen. In particular, the long-term outcomes of different antibiotic regimens, such as the recurrence rate, still lack evidence. Given that the flora of the appendix is mainly anaerobic bacteria, we hypothesised that antianaerobe regimens could decrease the recurrence rate compared with those that did not include antianaerobic antibiotics. METHODS AND ANALYSIS The OPTIMA(Optimising the treatment for uncomplicated acute appendicitis) trial is a multicentre, double-blinded placebo-controlled superiority randomised study aimed to evaluate the role of antianaerobic antibiotics in the resolution of uncomplicated AA. Patients (18-65 years) with uncomplicated AA (without gangrenous, perforated appendicitis, appendiceal abscess, or appendiceal fecaliths) are eligible for inclusion. The primary endpoint of this study is the success rate of the treatment, defined as the resolution of AA resulting in discharge from the hospital without surgical intervention and recurrent symptoms within one year. Secondary endpoints include mortality, postintervention complications, recurrent symptoms up to one year after treatment, hospital stay, sick leave, treatment cost, pain symptom scores and quality of life. Data are reported as the number of cases (%), median (range) and relative risk, which will be analysed using the Mann-Whitney U test or χ2 test, as appropriate. P-value<0.05 will be considered significant. ETHICS AND DISSEMINATION The protocol has been approved by the Ethics Committee of Jinling Hospital on 13 November 2018 (2018NZKY-027-01). The trial findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR1800018896.
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Affiliation(s)
- Jie Wu
- Department of General Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Haiyang Jiang
- Department of General Surgery, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Shikuan Li
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiuwen Wu
- Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peige Wang
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Robert Sawyer
- General Surgery Department, Western Michigan University, Kalamazoo, Michigan, USA
| | - Jianan Ren
- Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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18
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Roberts K. Impact of COVID-19 on appendicitis presentations in children in Australia and New Zealand. ANZ J Surg 2022; 92:736-741. [PMID: 35285164 PMCID: PMC9111244 DOI: 10.1111/ans.17566] [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: 10/26/2021] [Revised: 01/05/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND In contrast to many countries, the prevalence of COVID-19 in Australia and New Zealand has been low. We hypothesised, however, that a potential secondary effect of the COVID-19 pandemic would be delayed presentation of paediatric appendicitis, with resultant higher rates of complicated appendicitis. This study was an initiative of the Australian and New Zealand Surgery in Children Registrars' Association for Trials collaborative, a trainee-led research group based in Australia and New Zealand. METHODS A binational multicentre, retrospective review was undertaken of paediatric patients with appendicitis early in the COVID-19 pandemic (20 March-30 April 2020), compared with previous years (2018, 2019). Primary outcomes were the duration of symptoms prior to presentation and the severity of disease. RESULTS A total of 400 patients from six centres were included. Duration of symptoms prior to presentation, sepsis at presentation, complicated disease and presence of complications did not differ significantly between time periods. Duration of intravenous antibiotic treatment and overall antibiotic treatment were both significantly shorter during 2020 (2.4 days versus 3.5 in 2018 and 3.0 in 2019 [P = 0.0038] and 3.7 days versus 5.2 in 2018 and 4.6 in 2019 [P = 0.04], respectively). Management approach did not differ, with the majority of patients managed operatively. CONCLUSIONS We did not demonstrate any difference in duration of symptoms prior to presentation or other markers of disease severity early in the pandemic. Duration of antibiotic treatment was shorter during this period compared with previous years. Management of children with appendicitis, both simple and complicated, did not appear to change as a result of COVID-19.
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Affiliation(s)
- Kiera Roberts
- Department of Paediatric SurgeryTownsville University HospitalDouglasQueenslandAustralia
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19
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Jantzen AT, Bang-Nielsen A, Bertelsen CA, Torp-Pedersen C, Kleif J. Incidence of appendicitis during COVID-19 lockdown: A nationwide population-based study. Scand J Surg 2022; 111:14574969221089387. [PMID: 35488422 DOI: 10.1177/14574969221089387] [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: 11/16/2022]
Abstract
AIM To investigate how a nationwide lockdown influences the incidence of appendicitis. BACKGROUND Communitive infectious diseases may play a role in the pathogenesis of appendicitis as indicated by a seasonal variation in the incidence rate. The spread of communitive infectious diseases has decreased during the COVID-19 pandemic lockdown; thus, we have an opportunity to study the incidence rate of appendicitis in an environment with less impact from common community infections. METHODS The study is a nationwide register-based cohort study of the entire Danish population of 5.8 million. The difference in the incidence of appendicitis in a population subjugated to a controlled lockdown with social distancing (study group) was compared to a population not subjugated to a controlled lockdown and social distancing (reference group). RESULTS The relative risk of appendicitis during the lockdown was 0.92 (95% confidence interval (CI): 0.82-1.03, p = 0.131). The relative risk of complicated appendicitis during the lockdown was 0.68 (95% CI: 0.49-0.93, p = 0.02). The incidence of uncomplicated appendicitis was not significantly different during the national lockdown. CONCLUSIONS During the national lockdown of Denmark due to the COVID-19 pandemic the incidence of complicated appendicitis was reduced significantly compared to previous years, indicating that infectious disease might be a factor in the pathogenesis of appendicitis with complications. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov (NCT04407117).
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Affiliation(s)
- Amalie T Jantzen
- Department of Surgery Nordsjællands Hospital Dyrehavevej 29 Hillerød 3400 Denmark
| | | | - Claus A Bertelsen
- Department of Surgery, Nordsjællands Hospital, Hillerød, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Jakob Kleif
- Department of Surgery, Nordsjællands Hospital, Hillerød, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
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20
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Duraiswamy S, Ignacio A, Weinberg J, Sanchez SE, Flum DR, Paasche-Orlow MK, Kenzik KM, Tseng JF, Drake FT. Comparative Accuracy of ICD-9 vs ICD-10 Codes for Acute Appendicitis. J Am Coll Surg 2022; 234:377-383. [PMID: 35213502 DOI: 10.1097/xcs.0000000000000058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND ICD codes are used to identify patients with appendicitis and to classify disease severity for reimbursement and research purposes. We sought to compare the accuracy of ICD-9 vs ICD-10 codes in classifying appendicitis as uncomplicated vs complicated (defined as perforated, necrotic, or abscess) compared with the clinical gold standard: surgeon characterization of the appendix in the operative report. STUDY DESIGN This is a retrospective review of operative reports and discharge ICD-9/10 codes for patients 18 years or older who underwent noninterval, nonincidental appendectomy from January 2012 to December 2019 at a tertiary referral center. Sensitivity, specificity, and positive predictive value were calculated for ICD-9/10 codes to classify appendicitis as complicated when compared with surgeon description. Chi-square testing was used to compare agreement between ICD-9/10 codes and surgeon description. RESULTS A total of 1,585 patients underwent appendectomy. ICD-9 codes had higher sensitivity than ICD-10 codes for complicated appendicitis (sensitivity 0.84 and 0.54, respectively) and a similar positive predictive value (0.77 and 0.76, respectively). Overall, 91% of ICD-9 codes agreed with surgical description of disease, but 84.4% of ICD-10 codes agreed with surgical description (p < 0.01). Among cases classified as complicated by the surgeon, 84% (79/94) had an accurate ICD-9 code for complicated disease, but only 53.8% (57/106) of cases had an accurate ICD-10 code (p < 0.01). CONCLUSIONS Compared with ICD-9 codes, ICD-10 codes were less accurate in characterizing severity of appendicitis. The ICD-10 coding schema does not provide an accurate representation of disease severity. Until this system is improved, significant caution is needed for people who rely on these data for billing, quality improvement, and research purposes.
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Affiliation(s)
- Swetha Duraiswamy
- From the Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA (Duraiswamy, Sanchez, Tseng, Thurston Drake)
| | - Amanda Ignacio
- the Department of Biostatistics, Boston University School of Public Health, Boston, MA (Ignacio, Weinberg)
| | - Janice Weinberg
- the Department of Biostatistics, Boston University School of Public Health, Boston, MA (Ignacio, Weinberg)
| | - Sabrina E Sanchez
- From the Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA (Duraiswamy, Sanchez, Tseng, Thurston Drake)
| | - David R Flum
- the Department of Surgery, University of Washington Medical Center, Seattle, WA (Flum)
| | - Michael K Paasche-Orlow
- the Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, MA (Paasche-Orlow)
| | - Kelly M Kenzik
- the Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL (Kenzik)
| | - Jennifer F Tseng
- From the Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA (Duraiswamy, Sanchez, Tseng, Thurston Drake)
| | - Frederick Thurston Drake
- From the Department of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, MA (Duraiswamy, Sanchez, Tseng, Thurston Drake)
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21
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Monsell SE, Voldal EC, Davidson GH, Fischkoff K, Coleman N, Bizzell B, Price T, Narayan M, Siparsky N, Thompson CM, Ayoung-Chee P, Odom SR, Sanchez S, Drake FT, Johnson J, Cuschieri J, Evans HL, Liang MK, McGrane K, Hatch Q, Victory J, Wisler J, Salzberg M, Ferrigno L, Kaji A, DeUgarte DA, Gibbons MM, Alam HB, Scott J, Kao LS, Self WH, Winchell RJ, Villegas CM, Talan DA, Kessler LG, Lavallee DC, Krishnadasan A, Lawrence SO, Comstock B, Fannon E, Flum DR, Heagerty PJ. Patient Factors Associated With Appendectomy Within 30 Days of Initiating Antibiotic Treatment for Appendicitis. JAMA Surg 2022; 157:e216900. [PMID: 35019975 PMCID: PMC8756360 DOI: 10.1001/jamasurg.2021.6900] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Use of antibiotics for the treatment of appendicitis is safe and has been found to be noninferior to appendectomy based on self-reported health status at 30 days. Identifying patient characteristics associated with a greater likelihood of appendectomy within 30 days in those who initiate antibiotics could support more individualized decision-making. OBJECTIVE To assess patient factors associated with undergoing appendectomy within 30 days of initiating antibiotics for appendicitis. DESIGN, SETTING, AND PARTICIPANTS In this cohort study using data from the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) randomized clinical trial, characteristics among patients who initiated antibiotics were compared between those who did and did not undergo appendectomy within 30 days. The study was conducted at 25 US medical centers; participants were enrolled between May 3, 2016, and February 5, 2020. A total of 1552 participants with acute appendicitis were randomized to antibiotics (776 participants) or appendectomy (776 participants). Data were analyzed from September 2020 to July 2021. EXPOSURES Appendectomy vs antibiotics. MAIN OUTCOMES AND MEASURES Conditional logistic regression models were fit to estimate associations between specific patient factors and the odds of undergoing appendectomy within 30 days after initiating antibiotics. A sensitivity analysis was performed excluding participants who underwent appendectomy within 30 days for nonclinical reasons. RESULTS Of 776 participants initiating antibiotics (mean [SD] age, 38.3 [13.4] years; 286 [37%] women and 490 [63%] men), 735 participants had 30-day outcomes, including 154 participants (21%) who underwent appendectomy within 30 days. After adjustment for other factors, female sex (odds ratio [OR], 1.53; 95% CI, 1.01-2.31), radiographic finding of wider appendiceal diameter (OR per 1-mm increase, 1.09; 95% CI, 1.00-1.18), and presence of appendicolith (OR, 1.99; 95% CI, 1.28-3.10) were associated with increased odds of undergoing appendectomy within 30 days. Characteristics that are often associated with increased risk of complications (eg, advanced age, comorbid conditions) and those clinicians often use to describe appendicitis severity (eg, fever: OR, 1.28; 95% CI, 0.82-1.98) were not associated with odds of 30-day appendectomy. The sensitivity analysis limited to appendectomies performed for clinical reasons provided similar results regarding appendicolith (adjusted OR, 2.41; 95% CI, 1.49-3.91). CONCLUSIONS AND RELEVANCE This cohort study found that presence of an appendicolith was associated with a nearly 2-fold increased risk of undergoing appendectomy within 30 days of initiating antibiotics. Clinical characteristics often used to describe severity of appendicitis were not associated with odds of 30-day appendectomy. This information may help guide more individualized decision-making for people with appendicitis.
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Affiliation(s)
| | | | | | | | | | | | | | - Thea Price
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Callie M Thompson
- Vanderbilt University Medical Center, Nashville, Tennessee.,University of Utah, Salt Lake City
| | - Patricia Ayoung-Chee
- Tisch Hospital NYU Langone Medical Center, New York, New York.,Morehouse School of Medicine, Atlanta, Georgia
| | - Stephen R Odom
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Joseph Cuschieri
- Harborview Medical Center, UW Medicine, Seattle, Washington.,University of California, San Francisco
| | - Heather L Evans
- Harborview Medical Center, UW Medicine, Seattle, Washington.,University of South Carolina, Charleston
| | - Mike K Liang
- Lyndon B. Johnson General Hospital, University of Texas, Houston.,University of Houston, HCA Healthcare, Kingwood, Texas
| | | | | | - Jesse Victory
- Bellevue Hospital Center, NYU School of Medicine, New York, New York
| | - Jon Wisler
- Ohio State University Medical Center, Columbus
| | | | | | - Amy Kaji
- Harbor-UCLA Medical Center, West Carson, California
| | | | | | - Hasan B Alam
- University of Michigan Medical Center, Ann Arbor.,Northwestern University, Evanston, Illinois
| | - John Scott
- University of Michigan Medical Center, Ann Arbor
| | - Lillian S Kao
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston
| | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - David A Talan
- Olive View-UCLA Medical Center, Los Angeles, California.,Ronald Reagan UCLA Medical Center, Los Angeles, California
| | | | - Danielle C Lavallee
- University of Washington, Seattle.,BC Academic Health Science Network, Vancouver, Canada
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22
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Reismann M. A concise pathophysiological model of acute appendicitis against the background of the COVID-19 pandemic. Front Pediatr 2022; 10:908524. [PMID: 36313868 PMCID: PMC9606662 DOI: 10.3389/fped.2022.908524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
One of the most common clinical pictures has become the focus of attention during the COVID-19 pandemic: acute appendicitis with the associated diagnostics and therapy. The aim of the work is to show inconsistencies with regard to epidemiology, pathophysiology and therapy against the background of the pandemic with special attention to the conditions for children and to explain the pathophysiological processes that are likely to underlie the disease based on scientifically plausible models.
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Affiliation(s)
- Marc Reismann
- Department of Pediatric Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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23
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Impact of COVID-19 on the incidence of CT-diagnosed appendicitis and its complications in the UK and Sweden. Int J Colorectal Dis 2022; 37:1375-1383. [PMID: 35575916 PMCID: PMC9108134 DOI: 10.1007/s00384-022-04181-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
AIM To compare the number of appendicitis cases and its complications, during the first months of the COVID-19 pandemic in Sweden and the UK and the corresponding time period in 2019. METHOD Reports of emergency abdominopelvic CT performed at 56 Swedish hospitals and 38 British hospitals between April and July 2020 and a corresponding control cohort from 2019 were reviewed. Two radiologists and two surgeons blinded to the date of cohorts analyzed all reports for diagnosis of appendicitis, perforation, and abscess. A random selection of cases was chosen for the measurement of inter-rater agreement. RESULT Both in Sweden (6111) and the UK (5591) fewer, abdominopelvic CT scans were done in 2020 compared to 2019 (6433 and 7223, respectively); p < 0.001. In the UK, the number of appendicitis was 36% lower in April-June 2020 compared to 2019 but not in Sweden. Among the appendicitis cases, there was a higher number of perforations and abscesses in 2020, in Sweden. In the UK, the number of perforations and abscesses were initially lower (April-June 2020) but increased in July 2020. There was a substantial inter-rater agreement for the diagnosis of perforations and abscess formations (K = 0.64 and 0.77). CONCLUSION In Sweden, the number of appendicitis was not different between 2019 and 2020; however, there was an increase of complications. In the UK, there was a significant decrease of cases in 2020. The prevalence of complications was lower initially but increased in July. These findings suggest variability in delay in diagnosis of appendicitis depending on the country and time frame studied.
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24
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Head WT, Parrado RH, Cina RA. Impact of the Coronavirus (COVID-19) Pandemic on the Care of Pediatric Acute Appendicitis. Am Surg 2021:31348211067995. [PMID: 34957861 DOI: 10.1177/00031348211067995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appendicitis is the most common abdominal surgical emergency in children. With the rise of the Coronavirus-19 pandemic, quarantine measures have been enforced to limit the viral transmission of this disease. The purpose of this study was to identify differences in the clinical presentation and outcomes of pediatric acute appendicitis during the Coronavirus-19 pandemic. METHODS A single-institution retrospective assessment of all pediatric patients (<18 years old) with acute appendicitis from December 2019 to June 2020 was performed at a tertiary care children's hospital. Patients were divided into two groups: (1) the Pre-COVID group presented on or before March 15, 2020, and (2) the COVID group presented after March 15, 2020. Demographic, preoperative, and clinical outcomes data were analyzed. RESULTS 45 patients were included with a median age of 13 years [IQR 9.9 - 16.2] and 35 males (78%). 28 patients were in the Pre-COVID group (62%) and 17 in the COVID group (38%). There were no differences in demographics or use of diagnostic imaging. The COVID group did have a significantly delayed presentation from symptom onset (36 vs 24 hours, P < .05), higher Pediatric Appendicitis Scores (8 vs 6, P = .003), and longer hospital stays (2.2 vs 1.3 days, P = .04). There were no significant differences for rates of re-admission, re-operation, surgical site infection, perforation, or abscess formation. CONCLUSION During the Coronavirus-19 pandemic, the incidence of pediatric acute appendicitis was approximately 40% lower. These children presented in a delayed fashion with longer hospital stays. No differences were noted for postoperative complications.
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Affiliation(s)
- William T Head
- College of Medicine, 158155Medical University of South Carolina, Charleston, SC, USA
| | - Raphael H Parrado
- Division of Pediatric Surgery, Department of Surgery, 2345Medical University of South Carolina, Charleston, SC, USA
| | - Robert A Cina
- Division of Pediatric Surgery, Department of Surgery, 2345Medical University of South Carolina, Charleston, SC, USA
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25
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Mattingly AS, Rose L, Eddington HS, Trickey AW, Cullen MR, Morris AM, Wren SM. Trends in US Surgical Procedures and Health Care System Response to Policies Curtailing Elective Surgical Operations During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2138038. [PMID: 34878546 PMCID: PMC8655602 DOI: 10.1001/jamanetworkopen.2021.38038] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has affected every aspect of medical care, including surgical treatment. It is critical to understand the association of government policies and infection burden with surgical access across the United States. OBJECTIVE To describe the change in surgical procedure volume in the US after the government-suggested shutdown and subsequent peak surge in volume of patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted using administrative claims from a nationwide health care technology clearinghouse. Claims from pediatric and adult patients undergoing surgical procedures in 49 US states within the Change Healthcare network of health care institutions were used. Surgical procedure volume during the 2020 initial COVID-19-related shutdown and subsequent fall and winter infection surge were compared with volume in 2019. Data were analyzed from November 2020 through July 2021. EXPOSURES 2020 policies to curtail elective surgical procedures and the incidence rate of patients with COVID-19. MAIN OUTCOMES AND MEASURES Incidence rate ratios (IRRs) were estimated from a Poisson regression comparing total procedure counts during the initial shutdown (March 15 to May 2, 2020) and subsequent COVID-19 surge (October 22, 2020-January 31, 2021) with corresponding 2019 dates. Surgical procedures were analyzed by 11 major procedure categories, 25 subcategories, and 12 exemplar operative procedures along a spectrum of elective to emergency indications. RESULTS A total of 13 108 567 surgical procedures were identified from January 1, 2019, through January 30, 2021, based on 3498 Current Procedural Terminology (CPT) codes. This included 6 651 921 procedures in 2019 (3 516 569 procedures among women [52.9%]; 613 192 procedures among children [9.2%]; and 1 987 397 procedures among patients aged ≥65 years [29.9%]) and 5 973 573 procedures in 2020 (3 156 240 procedures among women [52.8%]; 482 637 procedures among children [8.1%]; and 1 806 074 procedures among patients aged ≥65 years [30.2%]). The total number of procedures during the initial shutdown period and its corresponding period in 2019 (ie, epidemiological weeks 12-18) decreased from 905 444 procedures in 2019 to 458 469 procedures in 2020, for an IRR of 0.52 (95% CI, 0.44 to 0.60; P < .001) with a decrease of 48.0%. There was a decrease in surgical procedure volume across all major categories compared with corresponding weeks in 2019. During the initial shutdown, otolaryngology (ENT) procedures (IRR, 0.30; 95% CI, 0.13 to 0.46; P < .001) and cataract procedures (IRR, 0.11; 95% CI, -0.11 to 0.32; P = .03) decreased the most among major categories. Organ transplants and cesarean deliveries did not differ from the 2019 baseline. After the initial shutdown, during the ensuing COVID-19 surge, surgical procedure volumes rebounded to 2019 levels (IRR, 0.97; 95% CI, 0.95 to 1.00; P = .10) except for ENT procedures (IRR, 0.70; 95% CI, 0.65 to 0.75; P < .001). There was a correlation between state volumes of patients with COVID-19 and surgical procedure volume during the initial shutdown (r = -0.00025; 95% CI, -0.0042 to -0.0009; P = .003), but there was no correlation during the COVID-19 surge (r = -0.00034; 95% CI, -0.0075 to 0.00007; P = .11). CONCLUSIONS AND RELEVANCE This study found that the initial shutdown period in March through April 2020, was associated with a decrease in surgical procedure volume to nearly half of baseline rates. After the reopening, the rate of surgical procedures rebounded to 2019 levels, and this trend was maintained throughout the peak burden of patients with COVID-19 in fall and winter; these findings suggest that after initial adaptation, health systems appeared to be able to self-regulate and function at prepandemic capacity.
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Affiliation(s)
| | - Liam Rose
- Health Economics Resource Center, Department of Veterans Affairs, Palo Alto, California
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
| | - Hyrum S. Eddington
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
| | - Amber W. Trickey
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
| | - Mark R. Cullen
- Stanford Center for Population Health Sciences, Stanford, California
| | - Arden M. Morris
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford, California
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Sherry M. Wren
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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26
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COVID-19 lockdown attack on headache emergency admissions: a multidisciplinary retrospective study. Neurol Sci 2021; 43:1575-1582. [PMID: 34822031 PMCID: PMC8614074 DOI: 10.1007/s10072-021-05569-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/14/2021] [Indexed: 11/09/2022]
Abstract
Background During the first COVID-19 lockdown in Italy, it was observed a reduction in emergency department (ED) attendances due to non-SARS-COV-2-related acute/chronic conditions. Objective To analyze the impact of the COVID-19 lockdown on patients reporting headache as the principal presenting symptom on admission to the ED of the tertiary care University Hospital of Trieste over the relevant period. Methods We retrospectively evaluated the frequency, features, and management of ED attendances for headache during the COVID-19 lockdown from 8 March to 31 May 2020, comparing it with the pre-lockdown period (January–February 2020) and the first 5 months of 2019. Results A reduction in ED total attendances was observed in the first 5 months of 2020 compared to the same period in 2019 (21.574 and 30.364, respectively; − 29%), in particular with respect to headache-related attendances (174 and 339 respectively; − 49%). During the COVID-19 lockdown, it was recorded a minor reduction in the ED access rate of female patients (p = 0.03), while no significant variation was detected in repeaters’ prevalence, diagnostic assessment, and acute treatment. The ratio of not otherwise specified, secondary, and primary headaches (48.4%, 30.6%, and 21.0% respectively) remained unchanged during the COVID-19 lockdown, in comparison to the control periods. Conclusion The COVID-19 pandemic impacted the number of ED attendances for headache but not their management and setting. Despite a reduction of accesses for headache due to the pandemic emergency, the distribution of headache subtypes and the rate of repeaters did not change.
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27
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Vansevičienė I, Bučinskaitė D, Malcius D, Lukošiūtė-Urbonienė A, Beržanskis M, Čekanauskas E, Barauskas V. Did the COVID-19 Pandemic Prolong the Time Till Diagnosis and Worsen Outcomes for Children with Acute Appendicitis? Medicina (B Aires) 2021; 57:medicina57111234. [PMID: 34833452 PMCID: PMC8623899 DOI: 10.3390/medicina57111234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
Background and Objectives: Our aim was to see if the COVID-19 pandemic led to an increase of time until diagnosis, operation, and time spent in Emergency room (ER), and if it resulted in more cases of complicated appendicitis and complication rates in children. Materials and Methods: We conducted a retrospective analysis of patients admitted to the Pediatric Surgery Department with acute appendicitis during a 4-month period of the first COVID-19 pandemic and compared it to the previous year data—the same 4-month period in 2019. Results: During the pandemic, the time spent in the ER until arriving at the department increased significantly 2.85 vs. 0.98 h p < 0.001, and the time spent in the department until the operation 5.31 vs. 2.66 h, p = 0.03. However, the time from the beginning of symptoms till ER, operation time and the length of stay at the hospital, as well as the overall time until operation did not differ and did not result in an increase of complicated appendicitis cases or postoperative complications. Conclusions: The COVID-19-implemented quarantine led to an increase of the time from the emergency room to the operating room by 4 h. This delay did not result in a higher rate of complicated appendicitis and complication rates, allowing for surgery to be postponed to daytime hours if needed.
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Affiliation(s)
- Idilė Vansevičienė
- Pediatric Surgery Department, Lithuanian University of Health Sciences, Eivenių Str. 2, LT-50161 Kaunas, Lithuania; (D.M.); (A.L.-U.); (M.B.); (E.Č.); (V.B.)
- Correspondence: ; Tel.: +370-6260-4046
| | - Danielė Bučinskaitė
- Department of Surgery, Lithuanian University of Health Sciences, Eivenių Str. 2, LT-50161 Kaunas, Lithuania;
| | - Dalius Malcius
- Pediatric Surgery Department, Lithuanian University of Health Sciences, Eivenių Str. 2, LT-50161 Kaunas, Lithuania; (D.M.); (A.L.-U.); (M.B.); (E.Č.); (V.B.)
| | - Aušra Lukošiūtė-Urbonienė
- Pediatric Surgery Department, Lithuanian University of Health Sciences, Eivenių Str. 2, LT-50161 Kaunas, Lithuania; (D.M.); (A.L.-U.); (M.B.); (E.Č.); (V.B.)
| | - Mindaugas Beržanskis
- Pediatric Surgery Department, Lithuanian University of Health Sciences, Eivenių Str. 2, LT-50161 Kaunas, Lithuania; (D.M.); (A.L.-U.); (M.B.); (E.Č.); (V.B.)
| | - Emilis Čekanauskas
- Pediatric Surgery Department, Lithuanian University of Health Sciences, Eivenių Str. 2, LT-50161 Kaunas, Lithuania; (D.M.); (A.L.-U.); (M.B.); (E.Č.); (V.B.)
| | - Vidmantas Barauskas
- Pediatric Surgery Department, Lithuanian University of Health Sciences, Eivenių Str. 2, LT-50161 Kaunas, Lithuania; (D.M.); (A.L.-U.); (M.B.); (E.Č.); (V.B.)
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Hayatghaibi SE, Trout AT, Dillman JR, Callahan M, Iyer R, Nguyen H, Riedesel E, Ayyala RS. Trends in Pediatric Appendicitis and Imaging Strategies During Covid-19 in the United States. Acad Radiol 2021; 28:1500-1506. [PMID: 34493456 PMCID: PMC8390378 DOI: 10.1016/j.acra.2021.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To determine if, during the first wave of the COVID-19 pandemic, 1) the proportion of complicated appendicitis changed, and 2) if imaging strategies for appendicitis in children changed. MATERIALS AND METHODS Retrospective cross-sectional study using administrative data from the Pediatric Health Information System, inclusive of pediatric patients diagnosed with appendicitis from March to May in 2017, 2018, 2019 and 2020. We compared trends during COVID-19 pandemic (March-May 2020) with corresponding pre-COVID-19 periods in 2017-201.9 Study outcomes were the proportion of complicated appendicitis and trends in imaging for appendicitis explained by patient-level variables. RESULTS The proportion of complicated appendicitis cases increased by 4.4 percentage points, from 46.5% pre-COVID-19 (2017-2019) to 50.9% during COVID-19 (2020), p < 0.001. Mean count of uncomplicated acute appendicitis cases decreased from pre-COVID-19 to the 2020 COVID-19 period (2017: n = 2555; 2018: n = 2679; 2019: n = 2722; 2020: n = 2231). Mean count of complicated appendicitis was unchanged between study periods (2017: n = 2189; 2018: n = 2302, 2019: n = 2442; 2020: n = 2311). Imaging approaches were largely unchanged between study periods; ultrasound was the most utilized modality in both study periods (68.3%, 70.2%; p = 0.033). CONCLUSION During the first wave of the COVID-19 pandemic, the proportion of complicated appendicitis cases increased without an absolute increase in the number of complicated appendicitis cases, but instead a decrease in the number of uncomplicated acute appendicitis diagnoses.
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Affiliation(s)
- Shireen E Hayatghaibi
- Department of Radiology, Texas Children's Hospital, Houston Texas; University of Texas, School of Public Health, Houston, Texas
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael Callahan
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramesh Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - HaiThuy Nguyen
- Department of Radiology, Texas Children's Hospital, Houston Texas
| | - Erica Riedesel
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Division of Pediatric Radiology, Children's Healthcare of Atlanta Division of Pediatric Radiology, Atlanta, Georgia
| | - Rama S Ayyala
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
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29
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Bauerle W, O'Laughlin M, Evans H. Improving Antibiotic Stewardship in Acute Appendicitis through Risk-Based Empiric Treatment Selection. Surg Infect (Larchmt) 2021; 23:61-65. [PMID: 34619064 DOI: 10.1089/sur.2021.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Empiric antimicrobial treatment selection for management of appendicitis is based on patient risk of infection with drug-resistant pathogens. Per Surgical Infection Society (SIS) guidelines, only high-risk patients should receive extended spectrum antibiotics. After observing substantial use of piperacillin-tazobactam at an academic medical center, a quality improvement initiative was developed targeting standardization of antibiotics for uncomplicated appendicitis. Patients and Methods: A project was performed to improve antibiotic stewardship in acute appendicitis treatment using plan-do-study-act methodology. We designed educational materials to guide risk-based empiric antimicrobial treatment selection for adult patients presenting with appendicitis. Implementation began January 1, 2020. High-risk criteria included presence of sepsis, presence of one or more comorbidities, and health-care-associated appendicitis. Retrospective chart review included adult patients admitted for appendectomy between January 1, 2019 and December 1, 2020. Pre-/post-implementation analysis and run chart analysis were performed. Primary outcome was the proportion of patients receiving the correct antibiotic. Secondary outcomes included antibiotic cost. Patients treated pre-/post-implementation were compared using univariable analysis, with statistical significance set at p < 0.05. Results: Of the 138 patients, 85 patients were in the pre-implementation group and 53 in the implementation group. The implementation group was 19.1% more likely to receive the correct antibiotic (pre = 31.8%; post = 50.9%; p = 0.03). Average cost per patient was reduced $13.25 (pre = $23.68 ± $18.76; post = $10.43 ± $8.45; p ≤ 0.0001). There were no differences in complications (pre = 2.4%; post = 0%; p = 0.26) or re-admissions (pre = 2.34%; post = 1.9%; p = 0.86). Conclusions: After an educational initiative to raise awareness about SIS guidelines for empiric antibiotic treatment for acute appendicitis, we observed an increase in the number of patients receiving the appropriate antibiotic. Prescribing habits were altered with no adverse impact on clinical outcomes. The next phase will address sustainability by incorporating an electronic medical record order set to integrate just-in-time education within the provider workflow.
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Affiliation(s)
- Wayne Bauerle
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Michael O'Laughlin
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Heather Evans
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Bowen JM, Sheen JRC, Whitmore H, Wright C, Bowling K. Acute appendicitis in the COVID-19 era: A complicated situation? Ann Med Surg (Lond) 2021; 67:102536. [PMID: 34230852 PMCID: PMC8252704 DOI: 10.1016/j.amsu.2021.102536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/29/2022] Open
Abstract
Acute appendicitis is the most common intra-abdominal surgical emergency in the world. Null hypothesis of no difference in the number of cases of complicated appendicitis. What impact did the government's ‘Stay at Home’ message have? Increasing body of evidence to support non-operative treatment in certain cases. A significantly higher rate of complicated cases found in the COVID era.
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Affiliation(s)
- Joel M Bowen
- Specialty Trainee Department of Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, UK
| | - Jonathon R C Sheen
- Specialty Trainee Department of Trauma & Orthopaedics, Torbay and South Devon NHS Foundation Trust, UK
| | - Helen Whitmore
- Specialty Trainee Department of Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, UK
| | - Chloe Wright
- Trust Doctor Department of General Surgery, Torbay and South Devon NHS Foundation Trust, UK
| | - Kirk Bowling
- Consultant Department of Upper G.I. Surgery, Torbay and South Devon NHS Foundation Trust, UK
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31
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Neufeld MY, Sanchez SE, Drake FT. Handle With Care: Use of Proportions to Assess Changes in Acute Appendicitis During the 2020 COVID-19 "Surge". J Am Coll Radiol 2021; 18:893-894. [PMID: 33775654 PMCID: PMC7985284 DOI: 10.1016/j.jacr.2021.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Miriam Y Neufeld
- Boston Medical Center, Department of Surgery, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 5th Floor, Boston, MA, 02118.
| | - Sabrina E Sanchez
- Boston Medical Center, Boston, Massachusetts; Assistant Professor of Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Frederick Thurston Drake
- Boston Medical Center, Boston, Massachusetts; Assistant Professor of Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
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Liberale G, Van Veer H, Lemaitre J, Duinslager M, Ysebaert D, De Roover A, de Gheldere C, Komen N. Impact of the first wave of the SARS-CoV-2/Covid-19 pandemic on digestive surgical activities: a Belgian National Survey. Acta Chir Belg 2021; 122:233-239. [PMID: 34077296 DOI: 10.1080/00015458.2021.1894735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Belgium was one of the first European countries affected by the first wave of the Covid-19 epidemic after Italy and France and has the highest rate of Covid-19-related deaths. Very few studies have evaluated the impact of the pandemic on surgical activity on a large scale. The primary objective of this national survey was to evaluate the impact of the first wave of the Covid-19 pandemic on surgical activities (elective non-oncological and oncological) in Belgian hospitals. METHODS A nationwide, multicenter survey was conducted in Belgium by the Royal Belgian Surgical Society (RBSS) board. The questionnaire focused on digestive surgical activity at different time points: period 1 (P1), before the epidemic; period 2 (P2), lockdown; and period 3 (P3), after stabilization of the epidemic. RESULTS The participation rate in the survey was 28.2% (24 out of 85 solicited hospitals), including 15 (62.5%) from the French speaking part of Belgium and 9 (37.5%) from the Flemish speaking part. Eighteen (75%) were non-academic and 6 (25%) were academic hospitals. All surgical activities were impacted by the Covid-19 pandemic except for the number of cholecystectomies. No statistical differences were observed between regions or according to the type of hospital. CONCLUSIONS Our national survey confirms that the COVID-19 outbreak has severely impacted in-person consultations and surgical activity for benign and malignant disease and for acute appendicitis. However, procedures for benign disease were much more affected than those for malignancies.
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Affiliation(s)
- Gabriel Liberale
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- BREATHE Laboratory, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Jean Lemaitre
- Department of Surgery, Ambroise-Paré Hospital, Mons, Belgium
| | - Marc Duinslager
- Department of Surgery, Academic Hospital, Vrije Universiteit van Brussel (VUB), Brussels, Belgium
| | - Dirk Ysebaert
- Department of Surgery, Antwerp Academic Hospital (UZA), Antwerp, Belgium
| | - Arnaud De Roover
- Department of Surgery, Université de Liège (ULG), Liège, Belgium
| | | | - Niels Komen
- Department of Surgery, Antwerp Academic Hospital (UZA), Antwerp, Belgium
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Gomez D, Simpson AN, Sue-Chue-Lam C, de Mestral C, Dossa F, Nantais J, Wilton AS, Urbach D, Austin PC, Baxter NN. A population-based analysis of the impact of the COVID-19 pandemic on common abdominal and gynecological emergency department visits. CMAJ 2021; 193:E753-E760. [PMID: 34035055 PMCID: PMC8177921 DOI: 10.1503/cmaj.202821] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Reduced use of the emergency department during the COVID-19 pandemic may result in increased disease acuity when patients do seek health care services. We sought to evaluate emergency department visits for common abdominal and gynecologic conditions before and at the beginning of the pandemic to determine whether changes in emergency department attendance had serious consequences for patients. METHODS We conducted a population-based analysis using administrative data to evaluate the weekly rate of emergency department visits pre-COVID-19 (Jan. 1-Mar. 10, 2020) and during the beginning of the COVID-19 pandemic (Mar. 11-June 30, 2020), compared with a historical control period (Jan. 1-July 1, 2019). All residents of Ontario, Canada, presenting to the emergency department with appendicitis, cholecystitis, ectopic pregnancy or miscarriage were included. We evaluated weekly incidence rate ratios (IRRs) of emergency department visits, management strategies and clinical outcomes. RESULTS Across all study periods, 39 691 emergency department visits met inclusion criteria (40.2 % appendicitis, 32.1% miscarriage, 21.3% cholecystitis, 6.4% ectopic pregnancy). Baseline characteristics of patients presenting to the emergency department did not vary across study periods. After an initial reduction in emergency department visits, presentations for cholecystitis and ectopic pregnancy quickly returned to expected levels. However, presentations for appendicitis and miscarriage showed sustained reductions (IRR 0.61-0.80), with 1087 and 984 fewer visits, respectively, after the start of the pandemic, relative to 2019. Management strategies, complications and mortality rates were similar across study periods for all conditions. INTERPRETATION Although our study showed evidence of emergency department avoidance in Ontario during the first wave of the COVID-19 pandemic, no adverse consequences were evident. Emergency care and outcomes for patients were similar before and during the pandemic.
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MESH Headings
- Abortion, Spontaneous/diagnosis
- Abortion, Spontaneous/epidemiology
- Abortion, Spontaneous/therapy
- Adult
- Aged
- Appendicitis/diagnosis
- Appendicitis/epidemiology
- Appendicitis/therapy
- COVID-19/epidemiology
- COVID-19/psychology
- Cholecystitis/diagnosis
- Cholecystitis/epidemiology
- Cholecystitis/therapy
- Cross-Sectional Studies
- Emergency Service, Hospital/trends
- Facilities and Services Utilization/trends
- Female
- Genital Diseases, Female/diagnosis
- Genital Diseases, Female/epidemiology
- Genital Diseases, Female/therapy
- Humans
- Male
- Middle Aged
- Ontario/epidemiology
- Pandemics
- Patient Acceptance of Health Care/statistics & numerical data
- Pregnancy
- Pregnancy, Ectopic/diagnosis
- Pregnancy, Ectopic/epidemiology
- Pregnancy, Ectopic/therapy
- Severity of Illness Index
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Affiliation(s)
- David Gomez
- Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Andrea N Simpson
- Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Colin Sue-Chue-Lam
- Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Charles de Mestral
- Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Fahima Dossa
- Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Jordan Nantais
- Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Andrew S Wilton
- Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - David Urbach
- Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Peter C Austin
- Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Nancy N Baxter
- Division of General Surgery (Gomez, Nantais), St. Michael's Hospital, Unity Health Toronto; ICES Central (Gomez, Simpson, de Mestral, Wilton, Urbach, Austin, Baxter); Department of Obstetrics and Gynecology (Simpson), St. Michael's Hospital, Unity Health Toronto; Department of Surgery (Sue-Chue-Lam, de Mestral, Dossa, Urbach), Faculty of Medicine, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
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Scheijmans JCG, Borgstein ABJ, Puylaert CAJ, Bom WJ, Bachiri S, van Bodegraven EA, Brandsma ATA, Ter Brugge FM, de Castro SMM, Couvreur R, Franken LC, Gaspersz MP, de Graaff MR, Groenen H, Kleipool SC, Kuypers TJL, Martens MH, Mens DM, Orsini RG, Reneerkens NJMM, Schok T, Sedee WJA, Tavakoli Rad S, Volders JH, Weeder PD, Prins JM, Gietema HA, Stoker J, Gisbertz SS, Besselink MGH, Boermeester MA. Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis: a comparison between 2019 and 2020. BMC Emerg Med 2021; 21:61. [PMID: 33980150 PMCID: PMC8114672 DOI: 10.1186/s12873-021-00454-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/23/2021] [Indexed: 01/03/2023] Open
Abstract
Background During the COVID-19 pandemic, a decrease in the number of patients presenting with acute appendicitis was observed. It is unclear whether this caused a shift towards more complicated cases of acute appendicitis. We compared a cohort of patients diagnosed with acute appendicitis during the 2020 COVID-19 pandemic with a 2019 control cohort. Methods We retrospectively included consecutive adult patients in 21 hospitals presenting with acute appendicitis in a COVID-19 pandemic cohort (March 15 – April 30, 2020) and a control cohort (March 15 – April 30, 2019). Primary outcome was the proportion of complicated appendicitis. Secondary outcomes included prehospital delay, appendicitis severity, and postoperative complication rates. Results The COVID-19 pandemic cohort comprised 607 patients vs. 642 patients in the control cohort. During the COVID-19 pandemic, a higher proportion of complicated appendicitis was seen (46.9% vs. 38.5%; p = 0.003). More patients had symptoms exceeding 24 h (61.1% vs. 56.2%, respectively, p = 0.048). After correction for prehospital delay, presentation during the first wave of the COVID-19 pandemic was still associated with a higher rate of complicated appendicitis. Patients presenting > 24 h after onset of symptoms during the COVID-19 pandemic were older (median 45 vs. 37 years; p = 0.001) and had more postoperative complications (15.3% vs. 6.7%; p = 0.002). Conclusions Although the incidence of acute appendicitis was slightly lower during the first wave of the 2020 COVID-19 pandemic, more patients presented with a delay and with complicated appendicitis than in a corresponding period in 2019. Spontaneous resolution of mild appendicitis may have contributed to the increased proportion of patients with complicated appendicitis. Late presenting patients were older and experienced more postoperative complications compared to the control cohort. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00454-y.
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Affiliation(s)
- Jochem C G Scheijmans
- Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Alexander B J Borgstein
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Carl A J Puylaert
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Wouter J Bom
- Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Said Bachiri
- Department of Surgery, Noordwest Hospital Group, Alkmaar, the Netherlands
| | | | | | | | | | - Roy Couvreur
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Lotte C Franken
- Departement of Surgery, Flevo Hospital, Almere, the Netherlands
| | - Marcia P Gaspersz
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Hannah Groenen
- Department of Surgery, Tergooi Hospitals, Hilversum, the Netherlands
| | | | - Toon J L Kuypers
- Department of Surgery, Elisabeth - Tweesteden Hospital, Tilburg, the Netherlands
| | - Milou H Martens
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands
| | - David M Mens
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Ricardo G Orsini
- Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | | | - Thomas Schok
- Department of Surgery, VieCuri Medisch Centrum for Noord-Limburg, Venlo, the Netherlands
| | - Wouter J A Sedee
- Department of Emergency Medicine, St Jansdal Hospital, Harderwijk, the Netherlands
| | | | - José H Volders
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Pepijn D Weeder
- Department of Surgery, Spaarne Gasthuis, Haarlem, and Hoofddorp, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc G H Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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35
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What special considerations should acute appendicitis bring to the clinician in the midst of Coronavirus Disease 2019. Surgery 2021; 169:1561-1562. [PMID: 33676731 PMCID: PMC7857010 DOI: 10.1016/j.surg.2021.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
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