Careful Non-operative Management with Surveillance of Acute Appendicitis During COVID-19 Pandemic

Abstract Background To determine on a national basis the surgical activity regarding appendectomies during the first Italian wave of the COVID-19 pandemic. Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. Methods Multicenter, observational study investigating the outcomes of patients undergoing appendectomy in the two months of March-April 2019 vs. March-April 2020. The primary outcome was the number of appendectomies performed during each of the two months, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs. open), and the complication rates. Results 1541 patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the study inclusion criteria. 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.8%) in 2019. Patients with complicated appendicitis operated in 2019 were 76 (9.6%) vs. 87 (15.9%) in 2020 (p = 0.001). An increase in the number of post-operative complications was found in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), having a unit AAST (+ 26%) increase, having waited for surgery > 24 h (+ 58%), being the surgeon aged > 40 years (+ 47%), undergoing open surgery (+ 112%) and being converted to open surgery (+ 166%). Conclusions In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. Patients undergoing surgery during the first pandemic wave were more frequently affected by more severe appendicitis than the previous year's timeframe and a higher complication rate was reported. Trial registration: ResearchRegistry ID 5789.

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Non-operative management of acute appendicitis: a review

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1600300039 ◽

2020 ◽

pp. 1709-1711

Author(s):

Bashaier Albalawi ◽

Kholood Alolayan ◽

Maryam Ansari ◽

Omar Alamoudi ◽

Ahdab Alsabhi ◽

...

Keyword(s):

Acute Appendicitis ◽

Operative Management ◽

Non Operative Management

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Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Updates in Surgery ◽

10.1007/s13304-021-01126-z ◽

2021 ◽

Author(s):

Alberto Sartori ◽

Mauro Podda ◽

Emanuele Botteri ◽

Roberto Passera ◽

Ferdinando Agresta ◽

...

Keyword(s):

Acute Appendicitis ◽

Open Surgery ◽

Primary Outcome ◽

New Technologies ◽

Operative Management ◽

Complication Rates ◽

Conversion To Open Surgery ◽

Registration Number ◽

Non Operative Management ◽

Pandemic Wave

AbstractMajor surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March–April 2019 vs March–April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020

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P61 Impact of the COVID-19 pandemic on the presentation and management of acute appendicitis: a single-centre analysis

BJS Open ◽

10.1093/bjsopen/zrab032.060 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

H Pringle ◽

U Donigiewicz ◽

M Bennett ◽

G F Fowler ◽

E Walker ◽

...

Keyword(s):

Acute Appendicitis ◽

Treatment Failure ◽

Medical Records ◽

Operative Management ◽

Open Appendicectomy ◽

Single Centre ◽

Delivery Of Healthcare ◽

The Uk ◽

Non Operative Management ◽

Guide Care

Abstract Introduction The COVID-19 pandemic has influenced the delivery of healthcare. In accordance with the UK Joint Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy where operative management (OM) s sought. Our aim is to share our experience of the presentation, management and outcomes for patients presenting to our Trust with AA to guide care for future viral pandemics. Methods This single-centre retrospective cohort study included patients diagnosed with AA in March to July 2019 compared with March to July 2020. Medical records were used to evaluate demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS), complications and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohort, respectively. 14 patients (9.4%) had NOM in 2019 versus 31 patients (24.8%) in 2020 (p = 0.001). In the 2019 OM group 125 patients (92.6%) had laparoscopic appendicectomy versus 69 (73.4%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days (interquartile range (IQR) 3 to 6 days) in 2019 and 3 days (IQR 2 to 5 days) in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who had OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one was negative. Conclusion During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

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Finding a place for non-operative management of acute appendicitis: COVID-19 as an example

The American Journal of Surgery ◽

10.1016/j.amjsurg.2021.09.003 ◽

2021 ◽

Author(s):

Sameh Hany Emile

Keyword(s):

Acute Appendicitis ◽

Operative Management ◽

Non Operative Management

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Non-operative management of uncomplicated acute appendicitis: using antibiotics is effective and decreases morbidity

Evidence-Based Medicine ◽

10.1136/eb-2012-100819 ◽

2012 ◽

Vol 18 (2) ◽

pp. 67-68 ◽

Cited By ~ 3

Author(s):

Rodney J Mason

Keyword(s):

Acute Appendicitis ◽

Operative Management ◽

Uncomplicated Acute Appendicitis ◽

Non Operative Management

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P066: Outcomes of non-operative versus operative management in pediatric acute uncomplicated appendicitis

CJEM ◽

10.1017/cem.2017.268 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S100

Author(s):

W. Janjua ◽

A. Janjua ◽

E. Loubani ◽

N. Merritt ◽

K. Van Aarsen

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Pediatric Population ◽

Retrospective Chart Review ◽

Operative Management ◽

Final Diagnosis ◽

Uncomplicated Appendicitis ◽

Long Term Follow Up ◽

Ed Visits ◽

Non Operative Management

Introduction: The purpose of this study was to look at outcomes of pediatric patients with early, acute appendicitis who were treated with non-operative management (NOM) with antibiotics. Primary outcomes were subsequent appendectomy or Emergency Department (ED) visits. Methods: The method used for this study was a retrospective chart review of children under the age of 18, looking at outcomes of those who received non-operative management (NOM) for early acute appendicitis between April 2014-April 2015. The inclusion criteria included: (a) Age 0-17, (b) US or CT suggested acute uncomplicated appendicitis (c) Final diagnosis of appendicitis during April 2014-2015. Outcomes that were investigated were repeat ED visits and need for subsequent appendectomy. Results: Data extracted from the EMR found 209 charts with an ED diagnosis of appendicitis. Two charts (.9%) were excluded as they were duplicates. Sixty-seven patients (32%) were excluded after appendicitis was ruled out. One hundred and forty patients (67%) had a final diagnosis of appendicitis, 124 patients (88.6%) were taken directly to the operating room for appendectomy, 16 patients (11.4%) were treated with antibiotics instead of operative management. Three patients who received non-operative management had complex appendicitis, 13 had acute uncomplicated appendicitis. Six patients out of 13 (46%) were successfully treated with antibiotics with no repeat visits to the ED or Pediatric Surgery for appendectomy, 7 patients (54%) required appendectomy after initial treatment with antibiotics. Two patients who underwent appendectomy after initial NOM had no evidence of clinical appendicitis, one patient was taken to the OR based on parent preference and one patient had an episode of abdominal pain that prompted an interval appendectomy four weeks post the episode of abdominal pain. Conclusion: Treatment of acute uncomplicated appendicitis with NOM remains a management option in the pediatric population. Further studies and long term follow up are required to better identify appropriate patients for non-operative management versus operative management.

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