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Alsunnary NJ, Al Turkistani L, Alhemaid S, Al Shehab F, Al Hashimi M, Elshafei H, Al-Buainain HM, Alkhudaimi RA, Alshaikh HN. Effect of COVID-19 Pandemic on Admission Pattern to Pediatric Surgery Division at King Fahad University Hospital and Subsequent Quality of Presentation in Cases: A Comparative Study and Single-Center Experience. Cureus 2024; 16:e66305. [PMID: 39252732 PMCID: PMC11382740 DOI: 10.7759/cureus.66305] [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: 08/05/2024] [Indexed: 09/11/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected healthcare systems worldwide, with mandatory quarantine and isolation measures being implemented to curb the spread of the virus. These measures have potentially led to delayed or complicated presentations of non-COVID-19 cases, including pediatric surgical cases. This study aims to evaluate pediatric surgical admission patterns, analyze the incidence of surgical diagnoses, and assess the severity of presentation during the COVID-19 period compared to the pre-COVID-19 period. This retrospective observational study was conducted at a university hospital in the eastern region of Saudi Arabia to assess the effect of the pandemic on pediatric surgery admissions patterns and severity of presentation during the COVID-19 period (March 2, 2020, to March 1, 2022) and pre-COVID-19 period (March 1, 2018, to March 1, 2020). Of the 903 pediatric surgical admissions, 366 (40.5%) presented during the COVID-19 period. The admission rate per month decreased by 6.9 during COVID-19 compared to pre-COVID-19 (mean [SD]: 21.5 [9.3] vs. 14.6 [8.2], p = 0.01). The most common admission diagnoses were appendicitis (17.5%) and inguinal hernia (15.8%). There was a 15% increase in the percentage of emergency admissions (54.4% vs. 47.3%, p = 0.037) during COVID-19 compared to pre-COVID-19. Of note, the percentage of patients admitted with acute appendicitis increased by 35.9% (20.8% vs. 15.3%, p = 0.03). Furthermore, the emergency admissions for patients with inguinal hernia doubled (26.6% vs. 12.7%, p = 0.035). No significant difference in ICU admissions, hospital length of stay, and routine discharge were observed. In conclusion, the COVID-19 pandemic correlated with a significant decrease in overall admissions and an increase in emergency admissions, including those for appendicitis and inguinal hernia. The increase in complicated conditions was not significant. There was no significant difference in ICU admissions and hospital length of stay. Future studies involving multiple centers are necessary to validate these findings.
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Bansal VV, Kamath Y, Waghmare S, Khajanchi MU, Roy N. Feasibility of tele-visits after elective ventral hernia surgery: Experience from an Indian tertiary care center. Surgery 2024; 176:211-213. [PMID: 38503605 DOI: 10.1016/j.surg.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Varun V Bansal
- Department of General Surgery, Seth G.S Medical College & K.E.M Hospital, Mumbai, India. http://www.twitter.com/Varun_VBSurg
| | - Yash Kamath
- Department of General Surgery, Seth G.S Medical College & K.E.M Hospital, Mumbai, India
| | - Sahil Waghmare
- Department of General Surgery, Seth G.S Medical College & K.E.M Hospital, Mumbai, India
| | - Monty U Khajanchi
- Department of General Surgery, Seth G.S Medical College & K.E.M Hospital, Mumbai, India
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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Fu G, Xu Z, Zhang S. Navigating appendicitis care during the Covid-19 pandemic: a retrospective cohort study in China. BMC Surg 2024; 24:166. [PMID: 38807152 PMCID: PMC11131191 DOI: 10.1186/s12893-024-02466-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The emergence of the COVID-19 pandemic in December 2019 initiated a global transformation in healthcare practices, particularly with respect to hospital management. PCR testing mandates for medical treatment seekers were introduced to mitigate virus transmission. AIMS This study examines the impact of these changes on the management of patients with appendicitis. METHODS We conducted a retrospective analysis of medical records for 748 patients diagnosed with appendicitis who underwent surgery at a tertiary care hospital during two distinct periods, the pre-pandemic year 2019 and the post-pandemic year 2021. Patient demographics, clinical characteristics, laboratory data, surgical outcomes, and hospital stay duration were assessed. RESULTS While no significant differences were observed in the general characteristics of patients between the two groups, the time from hospital visit to operation increased significantly during the pandemic. Unexpectedly, delayed surgical intervention was associated with shorter hospital stays but did not directly impact complication rates. There was no discernible variation in the type of surgery or surgical timing based on symptom onset. The pandemic also prompted an increase in appendicitis cases, potentially related to coronavirus protein expression within the appendix. CONCLUSIONS The COVID-19 pandemic has reshaped the landscape of appendicitis management. This study underscores the complex interplay of factors, including changes in hospital protocols, patient concerns, and surgical timing. Further research is needed to explore the potential link between COVID-19 and appendicitis. These insights are valuable for informing healthcare practices during and beyond the pandemic.
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Affiliation(s)
- Guang Fu
- The First Affiliated Hospital, Department of Gastrointestinal Surgery Hengyang Medical School, University of South China, Hengyang, 421001, China
| | - Zishun Xu
- The First Affiliated Hospital, Department of Gastrointestinal Surgery Hengyang Medical School, University of South China, Hengyang, 421001, China
| | - Shao Zhang
- The First Affiliated Hospital, Department of Gastrointestinal Surgery Hengyang Medical School, University of South China, Hengyang, 421001, China.
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Bavikatte A, Isswiasi S, Farag K. Unchanged Faces of Acute Appendicitis: Exploring Presentation and Treatment Amidst the COVID-19 Pandemic. Cureus 2024; 16:e60674. [PMID: 38770054 PMCID: PMC11104279 DOI: 10.7759/cureus.60674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The emergence of the COVID-19 pandemic necessitated the implementation of novel guidelines for managing appendicitis, prompting an evaluation of its effects on patient presentation and treatment at a district general hospital. Healthcare facilities worldwide have adapted protocols to meet the unique challenges of the pandemic, ensuring safe and efficient care. Our study assesses the pandemic's influence on patient demographics, clinical outcomes, surgical procedures, and adherence to guidelines among individuals undergoing emergency appendicitis surgery. Through this investigation, we aimed to determine whether significant deviations occurred in managing acute appendicitis amidst the pandemic. Methodology Consecutive adult patients (≥18 years) diagnosed with acute appendicitis were included in two cohorts for this retrospective analysis, comparing cases treated during the COVID-19 pandemic period (April to September 2020) with those treated one year prior. All patients underwent standardized assessments upon emergency department admission, including imaging studies and COVID-19 testing. Demographics, laboratory results, surgical details, and outcomes were compared between the pre- and post-pandemic groups, focusing on their overall management. Results The research involved a total of 172 individuals. During the pandemic (April to September 2020), 91 of these participants underwent surgery, which is more than the 81 individuals who had surgery during the same period the previous year (April to September 2019). Preoperative C-reactive protein levels were significantly higher in the pandemic group (P = 0.0455). The time from admission to surgery was shorter in the pandemic group (7.5 ± 4.6 vs. 5.8 ± 4.9; P = 0.0155). The overall operative and laparoscopic operative times were longer in the pandemic group (65 vs. 71 minutes, P = 0.391, and 55 vs. 62 minutes, P = 0.1424, respectively). However, these differences were not statistically significant. The number of patients presenting with complicated appendicitis was significantly higher in the pandemic group than in the nonpandemic group (44.4% vs. 61.4%; P = 0.034). The length of stay was shorter in the pandemic group (P = 0.53). Conclusions Our study suggests that surgery for acute appendicitis remains safe and feasible during the COVID-19 pandemic, with comparable outcomes. However, we noted an increase in the number of patients presenting with complicated appendicitis, possibly influenced by national pandemic guidelines in the United Kingdom. Despite this trend, our findings affirm the continued effectiveness of surgical management for acute appendicitis during the pandemic, highlighting the adaptability of healthcare systems in addressing emergent medical needs under challenging circumstances.
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Affiliation(s)
- Akshay Bavikatte
- General and Colorectal Surgery, West Suffolk Hospital NHS Trust, Bury St. Edmunds, GBR
| | - Sanad Isswiasi
- General Surgery, West Suffolk Hospital NHS Trust, Bury St. Edmunds, GBR
| | - Kyrllos Farag
- General Surgery, West Suffolk Hospital NHS Trust, Bury St. Edmunds, GBR
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Johnston DB, Coleman HG, Colvin D, Lawther S, Loughrey MB. Impact of COVID-19 on acute appendicitis presentation, management and pathology findings in adult and paediatric populations. PLoS One 2024; 19:e0300357. [PMID: 38630774 PMCID: PMC11023581 DOI: 10.1371/journal.pone.0300357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/23/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND We investigated the impact of the COVID-19 pandemic on trends of presentation, management and pathology findings in patients who underwent an appendicectomy for suspected acute appendicitis. METHOD The retrospective study reviewed patients (n = 939 adults and n = 329 children) who had an appendicectomy performed for suspected acute appendicitis and histopathology assessment in the Belfast Health and Social Care Trust, Northern Ireland. Pre-COVID-19 (March 2019 to February 2020) and COVID-19 Year 1 (March 2020 to February 2021) data were compared. Chi-squared tests were applied to compare timeframes. RESULTS 513 adult appendicectomies were performed in the immediate year pre-COVID-19, compared to 426 in COVID-19 Year 1, representing a 17% reduction. No such reduction was seen within the paediatric population, likely related to a change in regional paediatric referral criteria during the pandemic. When comparing COVID-19 Year 1 with pre-pandemic, fewer patients presented with <24 hours of symptoms (45% v 53%, p = 0.005), and there was greater use of pre-operative computed tomography imaging in adults (63.2% v 48.7%, p<0.001). Fewer adult and paediatric cases of simple acute appendicitis and non-diagnostic specimens, with relative increased proportions of perforated acute appendicitis, were observed in COVID-19 Year 1 compared with pre-pandemic. No absolute increase in perforated acute appendicitis cases was observed in adults. CONCLUSION Year 1 of the COVID-19 pandemic was associated with delayed presentation of acute appendicitis in adults and children. In adults, an overall reduction in appendicectomy operations, increased use of pre-operative diagnostic imaging, and fewer specimens showing simple acute appendicitis or non-diagnostic features, collectively support appropriate restriction of surgery for those patients with a more certain acute appendicitis diagnosis.
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Affiliation(s)
- Dorothy B. Johnston
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Helen G. Coleman
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - David Colvin
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Suzanne Lawther
- Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Maurice B. Loughrey
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
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V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
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Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Kupietzky A, Finkin M, Dover R, Eliezer Lourie NE, Mordechai-Heyn T, Juster EY, Mazeh H, Mizrahi I. Higher Rates of Complicated Appendicitis During the COVID-19 Pandemic: A Year-to-Year Analysis. J Surg Res 2023; 290:304-309. [PMID: 37329625 PMCID: PMC10208264 DOI: 10.1016/j.jss.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/03/2023] [Accepted: 05/12/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The COVID-19 pandemic impacted presentation, management strategies, and patient outcomes of numerous medical conditions. The aim of this study is to perform a year-to-year comparison of clinical outcomes of patients with acute appendicitis (AA) before and during the pandemic. METHODS Patients treated for AA during the initial 12-mo period of the pandemic at our institute were compared to those treated for AA during the 12-mo period before. Clinical and laboratory parameters, treatment strategies, intraoperative findings, pathology reports, and postoperative outcomes were compared. RESULTS During the study period, 541 patients presented with AA. The median (interquartile range) age was 28 (21-40) y and 292 (54%) were males. 262 (48%) patients presented during the pre-COVID-19 period, while 279 patients (52%) presented during the COVID 19 pandemic. The groups were comparable for baseline clinical data and imaging results upon index admission. There was no significant difference in rate of nonoperative treatment between the Pre-COVID-19 and During-COVID-19 eras (51% versus 53%, P = 0.6) as well as the success rate of such treatment (95.4% versus 96.4%, P = 0.3). Significantly more patients presented with a periappendicular abscess during COVID-19 (4.6% versus 1.1%, P = 0.01) and median (interquartile range) operative time was significantly longer (78 (61-90) versus 32.5 (27-45) min, P < 0.001). Pathology reports revealed a higher rate of perforated appendicitis during COVID-19 (27.4% versus 10.2%, P < 0.001). CONCLUSIONS Patients with AA present with higher rates of perforated and complicated appendicitis during the COVID-19 pandemic. The success rates of nonoperative management in selected patients with noncomplicated AA did not change during the pandemic and is a safe, feasible, option.
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Affiliation(s)
- Amram Kupietzky
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Miriam Finkin
- Faculty of Medicine, Department of Military Medicine and "Tzameret", Hebrew University of Jerusalem and Medical Corps, Israel Defense Forces, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roi Dover
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nachum Emil Eliezer Lourie
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tzlil Mordechai-Heyn
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Yonathan Juster
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Haggi Mazeh
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ido Mizrahi
- Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Bette S, Habeeballah O, Luitjens JH, Kroencke T, Scheurig-Muenkler C, Decker JA. Treatment of acute mesenteric ischemia between 2010 and 2020 - a German nation-wide study. BMC Gastroenterol 2023; 23:300. [PMID: 37674195 PMCID: PMC10481516 DOI: 10.1186/s12876-023-02926-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/12/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Aim of this study was to analyze long-term trends of hospitalizations, treatment regimen and in-hospital mortality of in-patients with acute mesenteric ischemia (AMI) over the past decade and effects of the SARS-CoV2-pandemic. METHODS We analyzed fully anonymized data from the German Federal Statistical Office of patients with AMI between 2010 and 2020. Besides descriptive analyses of age, gender, in-hospital mortality, comorbidity burden and treatment regimen, multivariable logistic regression analyses were performed to identify independent variables associated with in-hospital mortality and different treatment. RESULTS A total of 278,121 hospitalizations (120,667 male [43.4%], mean age 72.1 years) with AMI were included in this study. The total number of hospitalizations increased from 2010 (n = 24,172) to 2019 (n = 26,684) (relative increase 10.4%). In-hospital mortality decreased over the past decade from 36.6% to 2010 to 31.1% in 2019 (rel. decrease 15.2%). Independent risk factors for in-hospital mortality were older age (OR = 1.03 per year), higher comorbidity burden (OR = 1.06 per point in van Walraven score [vWs]), male gender (OR = 1.07), AMI as a secondary diagnosis (OR = 1.44), and the need for surgical (visceral surgery: OR = 1.38, vascular surgery: OR = 3.33) and endovascular treatment (OR = 1.21). We report a decline in hospitalizations during the first wave of infection in spring 2020 (rel. decrease 9.7%). CONCLUSION In-hospital mortality rate has declined over the past decade, but remains high at above 30%. Older age, increased comorbidity and male gender are independent factors for in-hospital mortality. Hospitalizations requiring vascular surgery are associated with high in-hospital mortality, followed by visceral surgery and endovascular approaches. The first wave of the SARS-CoV2-pandemic in spring 2020 implied a decrease in hospital admissions.
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Affiliation(s)
- Stefanie Bette
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Osama Habeeballah
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Jan H Luitjens
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Thomas Kroencke
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Universitätsstr. 2, 86159, Augsburg, Germany.
| | - Christian Scheurig-Muenkler
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Josua A Decker
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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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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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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Domenghino A, Staiger RD, Abbassi F, Serra-Burriel M, Leutwyler K, Aeby G, Turina M, Gutschow CA, Clavien PA, Puhan MA. Delivering Safe Surgical Care While Simultaneously Caring for Patients With COVID-19; Assessment of Patient Selection, Volume and Outcomes in a Tertiary Care Hospital. Int J Public Health 2023; 68:1605640. [PMID: 37051309 PMCID: PMC10083247 DOI: 10.3389/ijph.2023.1605640] [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: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Objectives: Compare patient selection and postoperative outcomes after surgical treatment for gastrointestinal disorders before and during the SARS-CoV-2 pandemic.Methods: We assessed gastrointestinal surgeries conducted at a tertiary center from 2017–2021 for differences in patient populations and procedures before (up to February 2020) and during the pandemic (March 2020 to December 2021). We analyzed mortality, Intensive Care Unit (ICU) length of stay, admission to ICU and postoperative complications for complex procedures using descriptive statistics and regression models.Results: 7309 procedures were analyzed, showing a caseload reduction in March and October 2020, but no statistical evidence for fewer overall procedures overall. Population characteristics differed with lower Body Mass Indices in 2020 and 2021, more patients smoking and with diabetes treated in 2020. There was no increased mortality, ICU length of stay and in 1,144 complex procedures assessed low overall morbidity at 90 days postoperative.Conclusion: Delivering surgical care while treating patients for COVID-19 in the same hospital was safe. Healthcare officials should consider continuing surgical care during future health crises as consequences of limiting surgical treatment for gastrointestinal disorders may be fatal for patients.
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Affiliation(s)
- Anja Domenghino
- Department of Surgery and Transplantation, University Hospital Zürich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zürich, Switzerland
| | - Roxane Diane Staiger
- Department of Surgery and Transplantation, University Hospital Zürich, Zurich, Switzerland
| | - Fariba Abbassi
- Department of Surgery and Transplantation, University Hospital Zürich, Zurich, Switzerland
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zürich, Switzerland
| | | | - Guillaume Aeby
- Department of Surgery and Transplantation, University Hospital Zürich, Zurich, Switzerland
| | - Matthias Turina
- Department of Surgery and Transplantation, University Hospital Zürich, Zurich, Switzerland
| | | | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zürich, Zurich, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zürich, Switzerland
- *Correspondence: Milo Alan Puhan,
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12
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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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13
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Londoño-Ruiz JP, Gutierrez-Tobar IF, Bermúdez-Bohórquez NL, Rodríguez AE. First publication of endemic channels as part of a pediatric Antimicrobial Stewardship Program: when to turn on the alarms? Recommendations of a pediatric ASP program. BMC Infect Dis 2023; 23:21. [PMID: 36631755 PMCID: PMC9833633 DOI: 10.1186/s12879-022-07916-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pediatric Antimicrobial Stewardship Programs (ASP) consider DOT a fundamental measure to quantify the impact of ASP. Novel strategies have been described, but no endemic channels (EC) have been reported to compare antibiotic use within historical patterns. This report describes the process of constructing an EC and analyzing its interpretation. METHODS This was a descriptive study of the construction, implementation, and analysis of EC. The median and quartile method, as well as the geometric mean (GM) and confidence interval (CI) methods using DOT for the last 4 years were used. ECs have also been elaborated on in critical services (PICU). RESULTS GM and CI method seem to be more sensitive in identifying changes in antimicrobial use. Ceftriaxone increased its use starting in December 2021, reaching the warning zone in March 2022 in relation to increased cases of bacterial and complicated pneumonia. Piperacillin-tazobactam showed an important increase in PICU during the first 8 months of 2021, reaching the alert zone until August 2021; thereafter, its use decreased, and this variation was related to a modification in the presentation of complicated appendicitis during the COVID 19 pandemic restrictions. The use of ampicillin-sulbactam has increased since January 2022 because of a change in local guidelines regarding its use in appendicitis and peritonitis. The changes identified in each EC allowed ASP to take different conducts. CONCLUSION EC allowed us to construct a new tool to measure ASP impact, internal comparison of antibiotic use facilitated taking timely interventions. EC could be useful for all pediatric and adult ASP.
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Affiliation(s)
- Juan Pablo Londoño-Ruiz
- Antimicrobial Stewardship Program, Clinica Infantil Colsubsidio, Bogotá, Colombia ,Pediatric Infectious Diseases, Clinica Infantil Santa Maria del Lago, Bogotá, Colombia ,grid.412191.e0000 0001 2205 5940Department of Pediatrics, Universidad del Rosario, Bogota, Colombia
| | - Ivan Felipe Gutierrez-Tobar
- Antimicrobial Stewardship Program, Clinica Infantil Colsubsidio, Bogotá, Colombia ,Pediatric Infectious Diseases, Clinica Infantil Santa Maria del Lago, Bogotá, Colombia
| | - Naddya Lheidy Bermúdez-Bohórquez
- Antimicrobial Stewardship Program, Clinica Infantil Colsubsidio, Bogotá, Colombia ,Pharmacy Department, Clinica Infantil Colsubsidio, Bogotá, Colombia
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14
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Saldaña CZ, Gutiérrez EG, Carlos ZC, Jose CA, Jean AV, Alejandro LP, Lopez CS. [Factors associated with prolonged hospital-stay after appendectomy during the SARS-CoV-2 pandemic]. Khirurgiia (Mosk) 2023:47-52. [PMID: 37916557 DOI: 10.17116/hirurgia202310147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To determine the factors associated with prolonged hospital-stay after appendectomy in SARS-CoV-2 pandemic. MATERIAL AND METHODS A retrospective observational cohort study included 420 patients after surgery for acute appendicitis between March 2019 and March 2020, April 2020 and April 2021. There were 336 patients before the SARS-COV-2 pandemic, and 84 ones underwent surgery during the pandemic. RESULTS Incidence of prolonged hospital stay was 15% and 26%, respectively (RR 1.76). RR is more than 1 and assumes SARS-CoV-2 infection as a risk factor. CONCLUSION There is an association between SARS-CoV-2 infection and prolonged hospital-stay after surgery for acute appendicitis (RR 1.76).
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Affiliation(s)
- C Z Saldaña
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - E G Gutiérrez
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - Z C Carlos
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - C-A Jose
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - A V Jean
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - L P Alejandro
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - C S Lopez
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
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15
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Frankcombe D, Gauri N, Satchithanandha V, Liang Y, Bak S, Suri T, Loxley D, Merrett N, Kaushal D. Management of acute appendicitis during the COVID-19 pandemic: a retrospective cohort study. BMC Surg 2022; 22:393. [PMID: 36397052 PMCID: PMC9670068 DOI: 10.1186/s12893-022-01851-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic profoundly impacted delivery of health care. South Western Sydney Local Health District (SWSLHD) experienced some of the highest cases, admissions and deaths during the Delta and Omicron waves in New South Wales. This study aims to determine the impact of the pandemic on emergency surgery services for adults presenting with acute appendicitis. METHODS A retrospective review of patient records was performed of adults presenting with acute appendicitis between 1st March 2021 and 31st March 2022, which was compared to a pre-COVID control period of the same dates in 2019-2020. Patients managed operatively or conservatively were included. RESULTS 1556 patients were included in the operative arm; 723 and 833 respectively in the study and control groups, which were comparable at baseline. 1.66% were COVID positive. During the pandemic, patients were significantly more likely to be investigated with computered tomography (CT) scan (p ≤ 0.001), present with complicated appendicitis (p = 0.03), and require caecectomy (p = 0.005). They had higher American Society of Anaesthesiology (ASA) scores (p = 0.001) and significantly lower negative appendectomy rates (p = 0.001). Fifty-two patients were included in the conservative arm; 29 and 23 respectively in the pandemic and control groups. Patients were comparable at baseline. There were two COVID positive patients. During the pandemic, there was a significant reduction in complications (p = 0.033), readmissions (0.044) and interval appendicectomy (p = 0.0044). CONCLUSION We identified higher rates of complicated appendicitis, caecectomies and greater reliance on CT imaging preoperatively during the pandemic in SWSLHD.
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Affiliation(s)
- D Frankcombe
- Department of Surgery, Campbelltown Public Hospital, Therry Road, Campbelltown, NSW, 2560, Australia.
| | - N Gauri
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - V Satchithanandha
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Y Liang
- Department of Surgery, Campbelltown Public Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
| | - S Bak
- University of Western Sydney, Campbelltown, Australia
| | - T Suri
- University of Western Sydney, Campbelltown, Australia
| | - D Loxley
- University of Western Sydney, Campbelltown, Australia
| | - N Merrett
- Department of Surgery, Campbelltown Public Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
- University of Western Sydney, Campbelltown, Australia
| | - D Kaushal
- Department of Surgery, Campbelltown Public Hospital, Therry Road, Campbelltown, NSW, 2560, Australia
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16
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Akbulut S, Tuncer A, Ogut Z, Sahin TT, Koc C, Guldogan E, Karabulut E, Tanriverdi ES, Ozer A. Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis. World J Clin Cases 2022; 10:10487-10500. [PMID: 36312473 PMCID: PMC9602222 DOI: 10.12998/wjcc.v10.i29.10487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/16/2022] [Accepted: 09/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute appendicitis (AAp) is the most frequent cause of acute abdominal pain, and appendectomy is the most frequent emergency procedure that is performed worldwide. The coronavirus disease 2019 (COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.
AIM To compare the demographic, clinical, and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.
METHODS The demographic, clinical, biochemical, and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19 (October 2018-March 2020) and COVID-19 (March 2020-July 2021) periods.
RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period. Pre-COVID-19 (n = 154) and COVID-19 (n = 223) periods were compared for various parameters, and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio (OR): 1.76; P = 0.018], presence of AAp findings on ultrasonography (OR: 15.4; P < 0.001), confirmation of AAp in the histopathologic analysis (OR: 2.6; P = 0.003), determination of perforation in the appendectomy specimen (OR: 2.2; P = 0.004), the diameter of the appendix (P < 0.001), and hospital stay (P = 0.003). There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19 (median: 24 h; interquartile range: 34) and COVID-19 (median: 36 h; interquartile range: 60) periods (P = 0.348). The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status (P < 0.001).
CONCLUSION The present study showed that in the COVID-19 period, the ultrasonographic determination rate of AAp, perforation rate of AAp, and duration of hospital stay increased. On the other hand, negative appendectomy rate decreased. There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.
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Affiliation(s)
- Sami Akbulut
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Adem Tuncer
- Department of Surgery, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Zeki Ogut
- Department of Surgery, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Tevfik Tolga Sahin
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Cemalettin Koc
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Emek Guldogan
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Ertugrul Karabulut
- Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Elif Seren Tanriverdi
- Department of Medical Microbiology, Inonu University Medical Faculty, Malatya 44280, Turkey
| | - Ali Ozer
- Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
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17
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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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18
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Tamara-López JA, Tamara Prieto J, Sierra-Peña AF, Fernández-Ávila DGFÁ. Apendicitis aguda durante la pandemia de COVID-19: experiencia en un centro de alta complejidad en Boyacá, Colombia. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introducción. La pandemia de COVID-19 replanteó la forma de atención en los sistemas de salud, afectando todas aquellas patologías no relacionadas con infecciones respiratorias, como la apendicitis aguda. El miedo al contagio por SARS-CoV-2 y las medidas restrictivas a la movilidad pudieron aumentar el tiempo desde el inicio de los síntomas hasta la consulta al servicio de urgencias, derivando en complicaciones intra y posoperatorias.
Métodos. Estudio observacional descriptivo de corte trasversal y retrospectivo, donde se incluyeron todos los pacientes diagnosticados con apendicitis aguda llevados a apendicectomía, que fueron divididos en dos grupos, considerados pre-pandemia, desde el 1° de septiembre de 2018 al 15 de marzo de 2020, y pandemia, desde el 16 de marzo de 2020 al 30 de septiembre de 2021.
Resultados. Fueron identificados 1000 pacientes, distribuidos en 501 pacientes en el grupo pre-pandemia y 499 en el grupo pandemia. El promedio de tiempo de consulta desde el momento de inicio de síntomas hasta consulta fue de 43 horas en el grupo pre-pandemia y de casi 45 horas en el grupo pandemia.
Discusión. A pesar de las restricciones por la enfermedad causada por el nuevo coronavirus y el miedo que puede existir por el contagio, en nuestro centro no se evidenció un cambio en el manejo y presentación de los pacientes diagnosticados con apendicitis aguda.
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19
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Poget M, Chautems R, Kohler R, Diana M, Saadi A. Impact of the COVID-19 pandemic on the severity and management of acute appendicitis. Front Surg 2022; 9:981885. [PMID: 36117810 PMCID: PMC9474729 DOI: 10.3389/fsurg.2022.981885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background The literature seems to indicate that the number of appendectomies dropped at the beginning of the coronavirus disease in 2019 (COVID-19 pandemic), while the number of complicated appendicitis increased due to late presentation. In addition, a longer delay before surgical treatment resulted in a higher morbidity. This study aims to compare the number of appendectomies, the severity, and the management of acute appendicitis during the first two pandemic peaks of COVID-19 with those observed during the same seasonal periods in the previous 2 years in a regional hospital in Switzerland. Methods We retrospectively reviewed and compared the number of appendectomies, rate of complicated appendicitis, delay to consultation and to surgery, distribution of appendectomies over a 24-h schedule, postoperative outcomes, and rates of overall complications in 177 patients, that is, 66 during the COVID-19 pandemic and 111 before the pandemic. Results No statistical difference was found in the number of appendectomies, duration of symptoms before consultation, median time to surgery, number of appendectomies performed outside the usual scheduled time for non-urgent surgery, length of postoperative stay, or the rates of overall complications. However, there was a trend in the rate of complicated appendicitis (p = .05). Conclusion In spite of a high incidence rate of COVID-19 in our canton, the impact of COVID-19 on our population did not follow the pattern observed elsewhere. The reasons for this might be that people would still present to the emergency department due to less strict social distancing measures. Great availability of emergency operating room may also account for the unchanged delay preceding surgical treatment and complication rates.
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Affiliation(s)
- Marion Poget
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Roland Chautems
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
- Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Rémy Kohler
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
- Surgery Department, Geneva University Hospitals, Geneva, Switzerland
| | - Michele Diana
- IRCAD, Research Institute Against Cancer of the Digestive System, Strasbourg, France
- Surgery Department, University Hospital of Strasbourg, Strasbourg, France
| | - Alend Saadi
- Surgery Department, Neuchâtel Hospital, Neuchâtel, Switzerland
- Obesity and Metabolic Diseases Center, Neuchâtel Hospital, Neuchâtel, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Correspondence: Alend Saadi
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20
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Wang F, Wu JM, Lin YC, Ho TW, Lin HL, Yu HY, Lai IR. Coronavirus Disease Pandemic Effect on Medical-Seeking Behaviors Even in One Resource-Competent Community: A Case Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710822. [PMID: 36078536 PMCID: PMC9518467 DOI: 10.3390/ijerph191710822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 05/21/2023]
Abstract
(1) Background: The coronavirus disease 2019 (COVID-19) pandemic had overwhelming impacts on medical services. During its initial surge, Taiwan was unique in maintaining its medical services without imposing travel restrictions, which provided an ideal environment in which to test if the fear of becoming infected with COVID-19 interfered with health-seeking behavior (HSB). We tested this hypothesis among adults with acute complicated appendicitis (ACA). (2) Methods: Adults with acute appendicitis were enrolled between 1 January and 30 June 2020 (COVID-19 period). The first two quarters of the preceding 3 years were defined as a historical control group. Outcome measures included the rate of ACA and the number of hospital stays. (3) Results: The COVID-19 era included 145 patients with acute appendicitis. Compared to the historical control (320 patients), the COVID-19 era was significantly associated with a higher length of symptom duration until presentation to the emergency room within >48 h (17.2% vs. 9.1%, p = 0.011), a higher incidence of ACA (29.7% vs. 19.4%, p = 0.014), and a longer length of hospital stays (5.0 days vs. 4.0 days, p = 0.043). The adjusted models showed that the COVID-19 period had a significant relationship with a higher rate of ACA (odds ratio (OR) = 1.87; 95% confidence interval (CI): 1.23-2.52; p = 0.008) and longer length of hospital stays (OR= 2.10; 95% CI: 0.92 to 3.31; p < 0.001). (4) Conclusions: The fear of COVID-19 may prohibit patients from seeking medical help, worsening their clinical outcomes. The surgical community should take action to provide scientific information to relive mental stress.
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Affiliation(s)
- Fang Wang
- Department of Nursing, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan
| | - Yi-Chieh Lin
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Te-Wei Ho
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Hui-Lin Lin
- Department of Nursing, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hsi-Yu Yu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Correspondence: (H.-Y.Y.); (I.-R.L.); Tel.: +886-2-23123456 (ext. 65107) (I.-R.L.)
| | - I-Rue Lai
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
- Correspondence: (H.-Y.Y.); (I.-R.L.); Tel.: +886-2-23123456 (ext. 65107) (I.-R.L.)
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21
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CAKCAK İE, KAPTAN M. COVID-19 pandemisinin inguinal herni cerrahi tedavisi üzerindeki etkisi: Tek bir merkezde retrospektif bir çalışma. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2022. [DOI: 10.25000/acem.1104456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: In this study, we aimed to examine the effect of the COVID 19 pandemic on the number, complication rates and epidemic characteristics of patients operated with the diagnosis of inguinal hernia in our institute.
Methods: We analyzed all patients who underwent inguinal hernia operation in Trakya University Faculty of Medicine, Dept of General Surgery, between March 11, 2019, and March 11, 2020, and compared them with the cases between March 11, 2020, and March 11, 2021, retrospectively. Percentages, mean, standard deviation, median and interquartile range were used as the descriptive statistics. Mann-Whitney U test was used for the variations which are contrary to the normal distribution range in the comparison of two groups. The relations between qualitative variations were studied by the Pearson Chi-Square test and Fisher's Exact test. Significant value was determined as 0.05 for all statistical analyses.
Results: Between March 11, 2019, and 2020, 65 patients were operated on (Group 1), and 26 patients between March 11, 2020, and 2021 (Group 2). The percentage of female patients was significantly higher in Group 2 (4.6% in Group 1, 23.1% in Group 2, p=0.008) and there was a statistically significant increase in the rate of incarceration and strangulation in Group 2 (44.6% in Group 1, 84.6% in Group 2, p=0.001).
Conclusions: During the COVID-19 pandemic the incarceration and strangulation rate was higher. The increase in complication rates can be attributed to the relative decrease in elective surgeries or the increase in the number of female patients admitted during the COVID period.
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22
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Kariya A, Krutsri C, Singhatas P, Sumritpradit P, Thampongsa T, Lertsitthichai P, Phoprom N. Incidence of complicated appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022; 45:100512. [PMID: 35845315 PMCID: PMC9273516 DOI: 10.1016/j.ijso.2022.100512] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Abduljubbar Kariya
- Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chonlada Krutsri
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsasit Singhatas
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Preeda Sumritpradit
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tharin Thampongsa
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Napaphat Phoprom
- Surgical Research Unit, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Kabir T, Syn NL, Shaw V, Tan YHA, Chua HW, Ong LWL, Koh FH, Ladlad J, Barco JB, Wang P, Kui Y, Blasiak A, Zhao JJ, Ho D, Kam JH, Ngaserin S. Defining the optimal time to appendectomy: A step toward precision surgery. Surgery 2022; 172:798-806. [PMID: 35850731 DOI: 10.1016/j.surg.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/06/2022] [Accepted: 04/09/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND We aimed to investigate the association between time from admission to appendectomy on perioperative outcomes in order to determine optimal time-to-surgery windows. METHODS We performed a retrospective review of all the appendectomies performed between July 2018 to May 2020. We first compared the perioperative outcomes using preselected time-to-surgery cut-offs, then determined optimal safe windows for surgery, and finally identified subgroups of patients who may require early intervention. RESULTS Six hundred twenty-one appendectomies were performed in the time period. The patients with a time-to-surgery of ≥12 hours had a significantly longer length of stay (median 2 days [interquartile range 1-3] vs 3 days [interquartile range 2-4], mean difference = 0.74 [95% confidence interval 0.32-1.17, P = .0006]) and higher 30-day readmission risk (odds ratio 2.58, 95% confidence interval 1.12-5.96, P = .0266) versus those with a time-to-surgery of <12 hours. These differences persisted when the time-to-surgery was dichotomized by <24 or ≥24 hours. A time-to-surgery beyond 25 hours was associated with a 3.34-fold increased odds of open conversion (P = .040), longer operation time (mean difference 15.8 mins, 95% confidence interval 3.4-28.3, P = .013) and longer postoperative length of stay (mean difference 10.3 hours, 95% confidence interval 3.4-20.2, P = .042) versus a time-to-surgery of <25 hours. The patients with time-to-surgery beyond 11 hours had a 1.35-fold increased odds of 30-day readmission (95% confidence interval 1.02-5.43, P = .046) compared with those who underwent appendectomy before 11 hours. Older patients, patients with American Society of Anesthesiologist score II to III, and individuals with long duration of preadmission symptoms had higher risk of prolonged operation time, open conversion, increased length of stay, and postoperative morbidity with increasing time-to-surgery. CONCLUSION This study identified the safe windows for appendectomy to be 11 to 25 hours from admission for most perioperative outcomes. However, certain patient subgroups may be less tolerant of surgical delays.
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Affiliation(s)
- Tousif Kabir
- Department of General Surgery, Sengkang General Hospital, Singapore.
| | - Nicholas L Syn
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore. https://twitter.com/Nicholas_Syn
| | - Vera Shaw
- Department of General Surgery, Sengkang General Hospital, Singapore
| | | | - Hui Wen Chua
- Department of General Surgery, Sengkang General Hospital, Singapore
| | | | - Frederick H Koh
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Jasmine Ladlad
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Jason Bae Barco
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Peter Wang
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore; The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - You Kui
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore; The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Agata Blasiak
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore; The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Biomedical Engineering, NUS Engineering, National University of Singapore, Singapore
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dean Ho
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore; The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Biomedical Engineering, NUS Engineering, National University of Singapore, Singapore
| | - Juinn Huar Kam
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Sabrina Ngaserin
- Department of General Surgery, Sengkang General Hospital, Singapore
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24
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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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25
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Ramsey ML, Patel A, Sobotka LA, Lim W, Kirkpatrick RB, Han S, Hart PA, Krishna SG, Lara LF, Lee PJ, Conwell DL, Papachristou GI. Hospital Trends of Acute Pancreatitis During the Coronavirus Disease 2019 Pandemic. Pancreas 2022; 51:422-426. [PMID: 35835114 PMCID: PMC9394202 DOI: 10.1097/mpa.0000000000002046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/21/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 pandemic led to changes in individuals' behaviors and healthcare delivery. We examined the impact of these changes on the rates and clinical course of acute pancreatitis (AP). METHODS Hospitalizations for AP from March 1 through August 31 in 2019 (baseline group) and the same period in 2020 (pandemic group) were retrospectively reviewed. Univariate and multivariate analyses were used for demographics and outcomes. RESULTS Two hundred eighty subjects (315 admissions) were identified in 2019 and 237 subjects (264 admissions) in 2020. Subjects in the pandemic group were more likely to have systemic inflammatory response syndrome (40% vs 25%, P < 0.01), pancreatic necrosis (14% vs 10%, P = 0.03), and persistent organ failure (17% vs 9%, P = 0.01) compared with prepandemic. There was no difference in etiology of AP. A multivariable model indicates that increased comorbidities, prior pancreatitis, pancreatic necrosis, and prescription of opiates at discharge were associated with 30-day readmissions during the pandemic. CONCLUSIONS Fewer patients were admitted for AP during the pandemic, suggesting that patients with milder symptoms avoided hospital interaction. Practices followed during the pandemic, especially avoidance of hospitalization and improved efficiency of hospital management, may reduce the burden of pancreatitis care in the future.
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Affiliation(s)
- Mitchell L. Ramsey
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Arsheya Patel
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Lindsay A. Sobotka
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Woobeen Lim
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH
| | - Robert B. Kirkpatrick
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Samuel Han
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Phil A. Hart
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Somashekar G. Krishna
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Luis F. Lara
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Peter J. Lee
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Darwin L. Conwell
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Georgios I. Papachristou
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
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26
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Huijgen D, de Wijkerslooth EML, Janssen JC, Beverdam FH, Boerma EJG, Dekker JWT, Kitonga S, van Rossem CC, Schreurs WH, Toorenvliet BR, Vermaas M, Wijnhoven BPL, van den Boom AL. Multicenter cohort study on the presentation and treatment of acute appendicitis during the COVID-19 pandemic. Int J Colorectal Dis 2022; 37:1087-1095. [PMID: 35415811 PMCID: PMC9005243 DOI: 10.1007/s00384-022-04137-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Current studies have demonstrated conflicting results regarding surgical care for acute appendicitis during the COVID-19 pandemic. This study aimed to assess trends in diagnosis as well as treatment of acute appendicitis in the Netherlands during the first and second COVID-19 infection wave. METHODS All consecutive patients that had an appendectomy for acute appendicitis in nine hospitals from January 2019 to December 2020 were included. The primary outcome was the number of appendectomies for acute appendicitis. Secondary outcomes included time between onset of symptoms and hospital admission, proportion of complex appendicitis, postoperative length of stay and postoperative infectious complications. Outcomes were compared between the pre-COVID group and COVID group. RESULTS A total of 4401 patients were included. The mean weekly rate of appendectomies during the COVID period was 44.0, compared to 40.9 in the pre-COVID period. The proportion of patients with complex appendicitis and mean postoperative length of stay in days were similar in the pre-COVID and COVID group (respectively 35.5% vs 36.8%, p = 0.36 and 2.0 ± 2.2 vs 2.0 ± 2.6, p = 0.93). There were no differences in postoperative infectious complications. A computed tomography scan was used more frequently as a diagnostic tool after the onset of COVID-19 compared to pre-COVID (13.8% vs 9.8%, p < 0.001, respectively). CONCLUSION No differences were observed in number of appendectomies, proportion of complex appendicitis, postoperative length of stay or postoperative infectious complications before and during the COVID-19 pandemic. A CT scan was used more frequently during the COVID-19 pandemic.
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Affiliation(s)
- Demi Huijgen
- Department of Surgery, Erasmus MC - University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | | | - Josephine C Janssen
- Department of Surgery, Erasmus MC - University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | | | - Evert-Jan G Boerma
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | - Sophia Kitonga
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | | | | | - Maarten Vermaas
- Department of Surgery, IJsselland Hospital, Capelle Aan Den IJssel, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC - University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Anne Loes van den Boom
- Department of Surgery, Erasmus MC - University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
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27
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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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28
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Sener Okur D, Memetoglu ME, Edirne Y. Impact of the COVID-19 pandemic and the restrictions on pediatric appendicitis in Turkey: A single-center experience. Pediatr Int 2022; 64:e15272. [PMID: 36074063 PMCID: PMC9349503 DOI: 10.1111/ped.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this study we investigated how the incidence and course of acute appendicitis (AA) changed in children during the pandemic. METHODS Children diagnosed with AA during the 1-year pandemic period after the first COVID-19 case in Turkey and the previous 1 year were included in the study. Children were divided into two groups: those hospitalized during the pandemic (group A) and those hospitalized in the year before the pandemic (group B). Furthermore, we compared the findings obtained for COVID-19-positive and COVID-19-negative children in the whole study group and within group A. RESULTS A significant difference was found between the two groups in terms of gender, the rate of vomiting and the number of days of vomiting. Complicated AA was more frequent in group B than in group A. In addition, the hospital stay was significantly longer, the mean number of days with fever was significantly higher, and mean body temperature was significantly higher in COVID-19-positive patients in the whole study group and within group A. CONCLUSIONS Contrary to most studies in the literature, in the present study the patients in the pre-pandemic period were admitted to hospital later, and this may have been associated with the higher frequency of complicated AA in these patients. During the pandemic, however, the arrangements and warnings of health authorities might have reduced the anxiety and the hesitancy of families to go to the hospital, and hence this may have been associated with the lower rate of complicated AA in this period.
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Affiliation(s)
- Dicle Sener Okur
- Division of Pediatric Infectious Diseases, Department of Pediatrics, State Hospital of Denizli, Denizli, Turkey
| | | | - Yesim Edirne
- Department of Pediatric Surgery, State Hospital of Denizli, Denizli, Turkey
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29
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Siegel R, Hohenstein S, Anders S, Strik M, Kuhlen R, Bollmann A. Access to Surgery and Quality of Care for Acute Cholecystitis During the COVID-19 Pandemic in 2020 and 2021 - an Analysis of 12,545 Patients from a German-Wide Hospital Network. J Gastrointest Surg 2022; 26:1462-1471. [PMID: 35445322 PMCID: PMC9020554 DOI: 10.1007/s11605-022-05318-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/26/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine effects on admission, treatment, and outcome for acute cholecystitis during the course of the COVID-19 pandemic in 2020 and 2021. METHODS Retrospective analysis of claims data from 74 German hospitals. Study periods were defined from March 5, 2020 (start of first wave) to June 20, 2021 (end of third wave) and compared to corresponding control periods (March 2018 to February 2020). All in-patients with acute cholecystitis were included. Distribution of cases, type of surgery, comorbidities, surgical outcome, and length of stay of all cases with acute cholecystitis and cholecystectomy were compared. In addition, we analyzed the type of treatment (non-surgical, cholecystostomy, or cholecystectomy) for all cases with main diagnosis of acute cholecystitis. RESULTS We could not demonstrate differences in daily admissions over the course of the pandemic (11.2-12.7 patients vs. 11.9-12.6 patients for control periods). Proportion of patients with non-surgical treatment was low and not increased (11.7-17.3% vs. 14.5-18.4%). Cholecystostomy was rare throughout all periods (0-0.5% of all patients). We did not observe an increase in open surgery (proportion of open cholecystectomies 3.4-5.5%). Mortality was generally low (1.5-1.9%) with no differences between periods. Median length of stay was 4 days throughout all periods. CONCLUSION The numerous restrictions during the COVID-19 pandemic did not result in an increase of admissions or surgery for acute cholecystitis. Laparoscopic cholecystectomy has been safely applied during the pandemic. Our results may assure the ability to maintain high quality of surgical care even in times of disruptions to the health care system.
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Affiliation(s)
- Robert Siegel
- grid.412581.b0000 0000 9024 6397Faculty of Health, Witten/Herdecke University, Witten, Germany ,grid.491869.b0000 0000 8778 9382Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Sven Hohenstein
- grid.9647.c0000 0004 7669 9786Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Stefan Anders
- grid.491869.b0000 0000 8778 9382Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Martin Strik
- grid.491869.b0000 0000 8778 9382Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | | | - Andreas Bollmann
- grid.9647.c0000 0004 7669 9786Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
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30
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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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31
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Impact of the COVID-19 pandemic on acute appendicitis in children. J Healthc Qual Res 2021; 37:225-230. [PMID: 35016871 PMCID: PMC8685178 DOI: 10.1016/j.jhqr.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/11/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022]
Abstract
Background and objectives Since the COVID-19 pandemic confinement was established in Spain on March 9, 2020, the number of visits to the pediatric Emergency Department (ED) has decreased dramatically, probably due to the fear of parents becoming infected in the hospital environment. The aim of this work was to analyze the medium-term consequences during the first 9 months after the onset of the COVID-19 pandemic in children with acute appendicitis (AA). Material and methods A retrospective study was performed on children operated on for AA in our institution between 2017 and 2020, who were distributed in two groups according to the date of surgery: COVID-19 group (after March 9, 2020) and control group (before March 9, 2020). Demographic variables, associated symptoms, time from symptoms onset, hospital stay, rate of complicated AA and postoperative complications were analyzed. Results A total of 1274 patients were included (288 COVID group; 986 control group), without demographic differences. Time from symptom onset was significantly longer in COVID-19 group (34.5 vs. 24.2 h; p = 0.021), although no differences in associated symptoms were observed between both groups. COVID-19 group presented a higher rate of complicated AA (20.1% vs. 14%; OR: 1.55; CI 95% [1.10–2.18]; p = 0.008), a longer hospital stay (3.5 vs. 2.8 days; p = 0.042) as well as a higher rate of postoperative complications (21.5% vs. 15.7%; OR: 1.47; CI 95% [(1.06–2.04)]; p = 0.008). Conclusion In our experience there was a negative medium-term effects of the COVID-19 pandemic on children with acute appendicitis: delayed ED visits, increased rate of complicated AA, increased hospital stay and increased postoperative complications.
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Decreased Incidence of Pediatric Intussusception during COVID-19. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111072. [PMID: 34828785 PMCID: PMC8625463 DOI: 10.3390/children8111072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) changed the epidemiology of various diseases. The present study retrospectively investigates the epidemiologic and clinical changes in pediatric intussusception for ages ≤ 7 years before (February 2019–January 2020) and after (February 2020–January 2021) the COVID-19 outbreak in a single pediatric emergency department of a university-affiliated tertiary hospital. The incidence of communicable diseases—defined as infectious diseases with the potential for human-to-human transmission via all methods, non-communicable diseases, and intussusception were decreased following the COVID-19 outbreak (15,932 to 3880 (24.4%), 12,994 to 8050 (62.0%), and 87 to 27 (31.0%), respectively). The incidence of intussusception correlated significantly with the change in incidence of communicable diseases (Poisson log-linear regression, odds ratio = 2.15, 95% CI = 1.08–4.26, and p = 0.029). Compared with the pre-pandemic period, patients of the pandemic period showed higher proportions of pathologic leading point (PLP) and hospitalization (14.8% vs. 2.3% and 18.5% vs. 4.6%, respectively), lower base excesses (−4.8 mmol/L vs. −3.6 mmol/L), and higher lactate concentrations (1.7 mmol/L vs. 1.5 mmol/L). The incidence of pediatric intussusception decreased after the COVID-19 pandemic. This reduced incidence may be related to the reduced incidence of communicable diseases. However, the proportions of more severe diseases and PLPs were higher after the COVID-19 pandemic.
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Does the COVID-19 Pandemic Affect Morbidity and Mortality Rates of Emergency General Surgery? A Retrospective Study from a Single-Center Tertiary Greek Hospital. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111185. [PMID: 34833403 PMCID: PMC8624623 DOI: 10.3390/medicina57111185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/29/2022]
Abstract
Background and Objectives: The outbreak of the COVID-19 pandemic had a major impact on all aspects of health care. Few up-to-date studies have actually assessed the impact of COVID-19 on emergency surgeries. The aim of this study was to provide an overview of the impact of the pandemic relating to the emergency surgery performed, as well as morbidity and mortality rates during the first year of the pandemic (March 2020–February 2021) and during the control period. In this period, the first propaedeutic surgery department and the third surgery department of the University General Hospital of Thessaloniki “AHEPA” in Greece provided continuous emergency general surgery services. Material and Methods: The study is in a retrospective cohort and included patients who were admitted to the Emergency Department and underwent emergency general surgery during the control period (n = 456), March 2019–February 2020 and during the first year of the pandemic (n = 223), March 2020–February 2021. Gender, age, type of surgical operation (morbidity), ICU need, the patient’s outcome, and days of hospitalization were compared. Results: A total of 679 emergency surgeries were included. Statistically significant differences emerged between the two time periods in the total number of emergency surgeries performed (p < 0.001). The most common type of surgery in the control period was associated with soft tissue infection while, during the pandemic period, the most common type of surgery was associated with the hepatobiliary system. In addition, the mortality rates nearly doubled during the pandemic period (2.2% vs. 4%). Finally, the mean age of our sample was 50.6 ± 17.5 and the majority of the participants in both time periods were males. Conclusions: The COVID-19 pandemic changed significantly the total number of emergency general surgeries performed. Mortality rates doubled and morbidity rates were affected between the control and pandemic periods. Finally, age, gender, length of hospitalization, intensive care unit hospitalization, and laparoscopy use in patients undergoing emergency surgery during the pandemic were stable.
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