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Thomas MB, Carmichael H, Harrison M, Abbitt D, Moore A, Myers QWO, Velopulos CG. Prioritizing rapid COVID-19 testing in emergency general surgery patients decreases burden of inpatient hospital admission. Trauma Surg Acute Care Open 2023; 8:e001085. [PMID: 37954921 PMCID: PMC10632905 DOI: 10.1136/tsaco-2023-001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/14/2023] [Indexed: 11/14/2023] Open
Abstract
Objectives The COVID-19 pandemic has changed delivery of emergency general surgery (EGS) and contributed to widespread bed shortages. At our institution, rapid testing is not routinely approved for EGS patients. We examined common EGS conditions (appendicitis and acute cholecystitis), hypothesizing that necessity of testing for COVID-19 significantly delayed operative intervention. Methods We performed a prepost study to examine a 2-month timeframe, or historical control, prior to COVID-19 testing (January 1, 2020-March 1, 2020) as well as a 2-month timeframe during the COVID-19 era (January 1, 2021-March 1, 2021). We chose conditions that are frequently treated surgically as outpatient or observation status. We examined time for COVID-19 test to result, and associated time to operative intervention (operating room (OR)) and need for admission. Results Median time to COVID-19 test results was 7.4 hours (IQR 5.8-13.1). For appendectomy, time to surgical consultation or case request did not differ between cohorts. Time to OR after case request was significantly longer (12.5 vs 1.9 hours, p<0.001) and patients more frequently required admission prior to operative intervention if receiving treatment in the COVID-19 timeframe. Similarly, for cholecystectomy there were no differences in time to surgical consultation or case request, but time to OR after case request was longer in the COVID-19 era (21.1 vs 9.0 hours, p<0.001). Conclusion While COVID-19 positivity rates have declined, the purpose of this study was to reflect on one element of our hospital system's response to the COVID-19 pandemic. Based on our institutional experience, waiting for COVID-19 test results directly impacts time to surgery, as well as the need for admission for a historically outpatient procedure. In the future, if the healthcare system is asked to respond to another pandemic or similar situation, expediting time to OR to eliminate unnecessary time in the hospital and non-critical admissions should be paramount. Level of evidence Level III, prognostic/epidemiological.
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Affiliation(s)
- Madeline B Thomas
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Heather Carmichael
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Madison Harrison
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Danielle Abbitt
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Allison Moore
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Quintin W O Myers
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Catherine G Velopulos
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
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Nguyen HV, Tran LH, Ly TH, Pham QT, Pham VQ, Tran HN, Trinh LT, Dinh TT, Pham DT, Mai Phan TA. Impact of the COVID-19 Pandemic on the Severity and Early Postoperative Outcomes of Acute Appendicitis. Cureus 2023; 15:e42923. [PMID: 37546691 PMCID: PMC10400342 DOI: 10.7759/cureus.42923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic caused changes in surgical practice. For acute appendicitis (AA), measures to control the pandemic might hinder patients from seeking medical care timely, resulting in increasing severity, postoperative complications, and mortality. This study aimed to investigate whether the COVID-19 pandemic had a negative impact on the severity and postoperative outcomes of patients with AA. Methodology We retrospectively reviewed medical records of AA patients treated operatively at Nhan Dan Gia Dinh Hospital hospital from June 1st to September 30th in three consecutive years: pre-pandemic (2019)/Group 1, minor waves (2020)/Group 2, and major wave (2021)/Group 3 (2021). Data were collected focusing on the duration of symptoms, severity of AA, time from admission to operation, postoperative complications, and mortality. Results There were 1,055 patients, including 452 patients in Group 1, 409 in Group 2, and 194 in Group 3. The overall number of patients decreased mainly in non-complicated AA. The percentages of hospital admission after 24 hours gradually increased (20.8%, 27.9%, and 43.8%, p < 0.05). The percentages of complicated AA in Group 2 and Group 3 were statistically higher than in Group 1 (39% and 55% vs. 31%, p < 0.05). Waiting time for operation increased to five hours during the major wave. Laparoscopic appendectomy was performed in 98-99% of AA patients during the pandemic, with an early postoperative complication rate of 5-9% and a mortality rate of 0.2-1%. Conclusions Although the percentages of hospital admission after 24 hours and complicated AA increased, laparoscopic appendectomy was still feasible and effective and should be maintained as the standard management for AA during the COVID-19 pandemic.
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Affiliation(s)
- Hai V Nguyen
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Loc H Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Tuan H Ly
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Quang T Pham
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, VNM
| | - Vu Q Pham
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Ha N Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Loc T Trinh
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Thien T Dinh
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Dinh T Pham
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Tuong Anh Mai Phan
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
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Henriksen SR, Christophersen C, Rosenberg J, Fonnes S. Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:205. [PMID: 37219616 DOI: 10.1007/s00423-023-02935-z] [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: 11/22/2022] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Appendicitis is a common cause of acute abdominal pain, and treatment with laparoscopy has become increasingly common during the past two decades. Guidelines recommend that normal appendices are removed if operated for suspected acute appendicitis. It is unclear how many patients are affected by this recommendation. The aim of this study was to estimate the rate of negative appendectomies in patients undergoing laparoscopic surgery for suspected acute appendicitis. METHODS This study was reported following the PRISMA 2020 statement. A systematic search was conducted in PubMed and Embase for retrospective or prospective cohort studies (with n ≥ 100) including patients with suspected acute appendicitis. The primary outcome was the histopathologically confirmed negative appendectomy rate after a laparoscopic approach with a 95% confidence interval (CI). We performed subgroup analyses on geographical region, age, sex, and use of preoperative imaging or scoring systems. The risk of bias was assessed using the Newcastle-Ottawa Scale. Certainty of the evidence was assessed using GRADE. RESULTS In total, 74 studies were identified, summing up to 76,688 patients. The negative appendectomy rate varied from 0% to 46% in the included studies (interquartile range 4-20%). The meta-analysis estimated the negative appendectomy rate to be 13% (95% CI 12-14%) with large variations between the individual studies. Sensitivity analyses did not change the estimate. The certainty of evidence by GRADE was moderate due to inconsistency in point estimates. CONCLUSION The overall estimated negative appendectomy rate after laparoscopic surgery was 13% with moderate certainty of evidence. The negative appendectomy rate varied greatly between studies.
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Affiliation(s)
- Siri R Henriksen
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark.
| | - Camilla Christophersen
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
| | - Jacob Rosenberg
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
| | - Siv Fonnes
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
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Won M, Ahn C. Epidemiology and Outcome of Acute Appendicitis during and before the COVID-19 Pandemic: A Retrospective Single-Center Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050902. [PMID: 37241134 DOI: 10.3390/medicina59050902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: We investigated epidemiological factors and outcomes, including the development of complications, for patients with appendicitis according to three sequential coronavirus disease 2019 (COVID-19) pandemic periods, divided by specific time points. Materials and Methods: This observational study included patients with acute appendicitis who arrived at a single-center between March 2019 and April 2022. The study divided the pandemic into three periods: period A as the first phase of the pandemic (from 1 March 2020 to 22 August 2021), period B as the time period the medical system stabilized (from 23 August 2021 to 31 December 2021), and period C as the time period of the exploration of patients with COVID-19 in South Korea (from 1 January 2022 to 30 April 2022). Data collection was based on medical records. The primary outcome was presence or absence of complications and the secondary outcomes were the time taken from ED visit to surgical intervention, the presence and time of the first administration of antibiotics, and the hospital stay time. Results: Of 1,101 patients, 1,039 were included, with 326 and 711 patients before and during the pandemic, respectively. Incidence of complications was not affected during the pandemic (before the pandemic 58.0%; period A 62.7%; period B,55.4%; and period C 58.1%; p = 0.358). Time from symptom onset to emergency department (ED) arrival significantly decreased during the pandemic (before the pandemic 47.8 ± 84.3 h; pandemic 35.0 ± 54 h; p = 0.003). Time from ED visit to the operating room was statistically significantly increased during the pandemic (before the pandemic 14.3 ± 21.67 h; period A 18.8 ± 14.02 h; period B 18.8 ± 8.57 h; period C 18.3 ± 12.95 h; p = 0.001). Age and time from symptom onset to ED arrival were variables affecting the incidence of complications; however, they were not affected during the pandemic (age, OR 2.382; 95% CI 1.545-3.670; time from symptom onset to ED arrival, OR 1.010, 95% CI 1.006-1.010; p < 0.001). Conclusions: This study found no differences in postoperative complications or treatment durations between pandemic periods. The incidence of appendicitis complications was significantly influenced by age and the duration between the onset of symptoms and arrival at the emergency department, but not by the pandemic period itself.
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Affiliation(s)
- Moonho Won
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
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Okuyan GÇ, Yıldırım M. The effect of the COVID-19 pandemic on the outcomes of surgically treated colorectal diseases: a retrospective cohort study. Ann Surg Treat Res 2022; 103:104-111. [PMID: 36017140 PMCID: PMC9365639 DOI: 10.4174/astr.2022.103.2.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/03/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The objective of this study is to evaluate the effect of the coronavirus disease 2019 (COVID-19) pandemic on elective and emergent colorectal surgical practice. Methods The population of this retrospective observational study consisted of all consecutive patients who underwent emergent or elective colorectal surgery between March 2019 and March 2021. The patients were divided into 2 groups: the prepandemic group who were treated between March 2019 and March 10, 2020, and the pandemic group who were treated between March 11, 2020 and March 2021. The rate of emergent operations was the primary outcome. The groups were compared based on the frequency of operations, distribution of tumoral features in malignant cases, and 90th-day mortality rates. Results There were 180 and 121 patients in the prepandemic and pandemic groups, respectively. There were significantly more patients of the American Society of Anesthesiologists physical status stage IV with comorbidity in the pandemic group than in the prepandemic group (P = 0.016 and P < 0.001, respectively). The rate of emergent operations was significantly higher in the pandemic group than in the prepandemic group (49.6% vs. 26.7%, P < 0.001). There were significantly more patients who received non-resectional surgery in the pandemic group than in the prepandemic group (P = 0.002). Additionally, there were significantly more patients without resection among patients with a defunctioning stoma (P = 0.001). The length of hospital stay (LoS) was significantly shorter in the pandemic group than in the prepandemic group (P = 0.039). On the other hand, the mortality rate was significantly higher in the pandemic group than in the prepandemic group (15.7% vs. 6.1%, P = 0.011). Conclusion The study findings suggested that the COVID-19 pandemic adversely affected colorectal surgical practices, resulting in more frequent emergent operations, non-resectional procedures with stoma formation, and higher mortality rates.
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Affiliation(s)
- Gülten Çiçek Okuyan
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Melih Yıldırım
- Department of General Surgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
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Choi YS, Yi JW, Chung CTY, Shin WY, Choi SK, Heo YS. Clinical Experience of Emergency Appendectomy under the COVID-19 Pandemic in a Single Institution in South Korea. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060783. [PMID: 35744046 PMCID: PMC9230818 DOI: 10.3390/medicina58060783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The COVID-19 pandemic has brought serious changes in healthcare systems worldwide, some of which have affected patients who need emergency surgery. Acute appendicitis is the most common surgical disease requiring emergency surgery. This study was performed to determine how the COVID-19 pandemic has changed the treatment of patients with acute appendicitis in South Korea. Materials and Methods: We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis in our hospital from January 2019 to May 2021. We classified the patients into two groups according to whether they were treated before or after the COVID pandemic and 10 March 2020 was used as the cutoff date, which is when the World Health Organization declared the COVID pandemic. Results: A total of 444 patients were included in the “Pre-COVID-19” group and 393 patients were included in the “COVID-19” group. In the “COVID-19” group, the proportion of patients with severe morbidity was significantly lower. The time that the patients spent in the emergency room before surgery was significantly longer in the ”COVID-19” group (519.11 ± 486.57 min vs. 705.27 ± 512.59 min; p-value < 0.001). There was no difference observed in the severity of appendicitis or in the extent of surgery between the two groups. Conclusions: During the COVID-19 pandemic, a statistically significant time delay (186.16 min) was needed to confirm COVID-19 infection status. However, there was no clinical difference in the severity of appendicitis or in the extent of surgery. To ensure the safety of patients and medical staff, a COVID-19 PCR test should be performed.
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An S, Kim HR, Jang S, Kim K. The Impact of the Coronavirus Disease - 19 Pandemic on the Clinical Characteristics and Treatment of Adult Patients with Acute Appendicitis. Front Surg 2022; 9:878534. [PMID: 35433818 PMCID: PMC9009369 DOI: 10.3389/fsurg.2022.878534] [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: 02/18/2022] [Accepted: 03/21/2022] [Indexed: 01/08/2023] Open
Abstract
PurposeThis study aimed to investigate the characteristics, severity, and treatment of adult patients with acute appendicitis in Korea over a 2-year period during the coronavirus disease (COVID-19) pandemic compared to those before the pandemic. We also investigated whether there were any changes in clinical characteristics of acute appendicitis before and after vaccination against the coronavirus.MethodsWe retrospectively reviewed the medical records of patients who were diagnosed with acute appendicitis at our institution between March 1, 2019, and August 31, 2021. We divided the patients into three groups (pre-pandemic, before vaccination, and after vaccination) and analyzed the clinical outcomes.ResultsThe time from symptom onset to hospital arrival and the time from symptom onset to operation increased during the COVID-19 pandemic period compared to the pre-pandemic period. The rate of complicated appendicitis during the pandemic was higher than that before the pandemic. In addition, the number of new daily cases showed a positive correlation with the time from symptom onset to hospital arrival (OR, 0.03; 95% CI, 0.02 to 0.04; P < 0.001) and complicated appendicitis (OR, 1.002; 95% CI, 1.001–1.002; P = 0.0017). The vaccination rate showed a negative correlation with the time from symptom onset to hospital arrival (OR, −2.26; 95% CI, −3.42 to −1.11; P < 0.001) and complicated appendicitis (OR, 0.915; 95% CI, 0.84 to 0.996; P = 0.0404).ConclusionsEmploying hospital-wide efforts, such as screening by rapid PCR testing, to avoid further time delays, and nationwide efforts, such as vaccination, to shorten the time from symptom onset to hospital arrival, are necessary to maintain the quality of treatment of acute appendicitis during an infectious disease pandemic.
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Affiliation(s)
- Sanghyun An
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hae-Rim Kim
- College of Natural Science, School of Statistics, University of Seoul, Seoul, Korea
| | - Sungwoo Jang
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kwangmin Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
- Correspondence: Kwangmin Kim
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El Nakeeb A, Emile SH, AbdelMawla A, Attia M, Alzahrani M, ElGamdi A, Nouh AE, Alshahrani A, AlAreef R, Kayed T, Hamza HM, AlMalki A, Rayzah F, Alsharif M, Alsharif F, Mohammed MM. Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East-a multicentre prospective cohort study. Int J Colorectal Dis 2022; 37:777-789. [PMID: 35152340 PMCID: PMC8853311 DOI: 10.1007/s00384-022-04108-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic had a striking impact on healthcare services in the world. The present study aimed to investigate the impact of the COVID-19 pandemic on the presentation management and outcomes of acute appendicitis (AA) in different centers in the Middle East. METHODS This multicenter cohort study compared the presentation and outcomes of patients with AA who presented during the COVID-19 pandemic in comparison to patients who presented before the onset of the pandemic. Demographic data, clinical presentation, management strategy, and outcomes were prospectively collected and compared. RESULTS Seven hundred seventy-one patients presented with AA during the COVID pandemic versus 1174 in the pre-COVID period. Delayed and complex presentation of AA was significantly more observed during the pandemic period. Seventy-six percent of patients underwent CT scanning to confirm the diagnosis of AA during the pandemic period, compared to 62.7% in the pre-COVID period. Non-operative management (NOM) was more frequently employed in the pandemic period. Postoperative complications were higher amid the pandemic as compared to before its onset. Reoperation and readmission rates were significantly higher in the COVID period, whereas the negative appendicectomy rate was significantly lower in the pandemic period (p = 0.0001). CONCLUSION During the COVID-19 pandemic, a remarkable decrease in the number of patients with AA was seen along with a higher incidence of complex AA, greater use of CT scanning, and more application of NOM. The rates of postoperative complications, reoperation, and readmission were significantly higher during the COVID period.
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Affiliation(s)
| | | | | | | | - Mohamed Alzahrani
- Khamis Mushait General Hospital, Aseer region, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ayman ElGamdi
- Khamis Mushait General Hospital, Aseer region, Khamis Mushait, Kingdom of Saudi Arabia
| | - Abd elwahab Nouh
- Khamis Mushait General Hospital, Aseer region, Khamis Mushait, Kingdom of Saudi Arabia
| | - Abdulaziz Alshahrani
- Khamis Mushait General Hospital, Aseer region, Khamis Mushait, Kingdom of Saudi Arabia
| | - Riyadh AlAreef
- Khamis Mushait General Hospital, Aseer region, Khamis Mushait, Kingdom of Saudi Arabia
| | | | | | - Ahmad AlMalki
- Aseer Central Hospital, Aseer region, Abha, Kingdom of Saudi Arabia
| | - Fares Rayzah
- Aseer Central Hospital, Aseer region, Abha, Kingdom of Saudi Arabia
| | - Motaz Alsharif
- Aseer Central Hospital, Aseer region, Abha, Kingdom of Saudi Arabia
| | - Fares Alsharif
- Aseer Central Hospital, Aseer region, Abha, Kingdom of Saudi Arabia
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