Did the COVID-19 Pandemic Prolong the Time Till Diagnosis and Worsen Outcomes for Children with Acute Appendicitis?

Background and Objectives: Our aim was to see if the COVID-19 pandemic led to an increase of time until diagnosis, operation, and time spent in Emergency room (ER), and if it resulted in more cases of complicated appendicitis and complication rates in children. Materials and Methods: We conducted a retrospective analysis of patients admitted to the Pediatric Surgery Department with acute appendicitis during a 4-month period of the first COVID-19 pandemic and compared it to the previous year data—the same 4-month period in 2019. Results: During the pandemic, the time spent in the ER until arriving at the department increased significantly 2.85 vs. 0.98 h p < 0.001, and the time spent in the department until the operation 5.31 vs. 2.66 h, p = 0.03. However, the time from the beginning of symptoms till ER, operation time and the length of stay at the hospital, as well as the overall time until operation did not differ and did not result in an increase of complicated appendicitis cases or postoperative complications. Conclusions: The COVID-19-implemented quarantine led to an increase of the time from the emergency room to the operating room by 4 h. This delay did not result in a higher rate of complicated appendicitis and complication rates, allowing for surgery to be postponed to daytime hours if needed.

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Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis: a comparison between 2019 and 2020

BMC Emergency Medicine ◽

10.1186/s12873-021-00454-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jochem C. G. Scheijmans ◽

◽

Alexander B. J. Borgstein ◽

Carl A. J. Puylaert ◽

Wouter J. Bom ◽

...

Keyword(s):

Postoperative Complications ◽

Acute Appendicitis ◽

Primary Outcome ◽

Complicated Appendicitis ◽

Spontaneous Resolution ◽

Complication Rates ◽

Control Cohort ◽

Prehospital Delay ◽

Number Of Patients ◽

Secondary Outcomes

Abstract Background During the COVID-19 pandemic, a decrease in the number of patients presenting with acute appendicitis was observed. It is unclear whether this caused a shift towards more complicated cases of acute appendicitis. We compared a cohort of patients diagnosed with acute appendicitis during the 2020 COVID-19 pandemic with a 2019 control cohort. Methods We retrospectively included consecutive adult patients in 21 hospitals presenting with acute appendicitis in a COVID-19 pandemic cohort (March 15 – April 30, 2020) and a control cohort (March 15 – April 30, 2019). Primary outcome was the proportion of complicated appendicitis. Secondary outcomes included prehospital delay, appendicitis severity, and postoperative complication rates. Results The COVID-19 pandemic cohort comprised 607 patients vs. 642 patients in the control cohort. During the COVID-19 pandemic, a higher proportion of complicated appendicitis was seen (46.9% vs. 38.5%; p = 0.003). More patients had symptoms exceeding 24 h (61.1% vs. 56.2%, respectively, p = 0.048). After correction for prehospital delay, presentation during the first wave of the COVID-19 pandemic was still associated with a higher rate of complicated appendicitis. Patients presenting > 24 h after onset of symptoms during the COVID-19 pandemic were older (median 45 vs. 37 years; p = 0.001) and had more postoperative complications (15.3% vs. 6.7%; p = 0.002). Conclusions Although the incidence of acute appendicitis was slightly lower during the first wave of the 2020 COVID-19 pandemic, more patients presented with a delay and with complicated appendicitis than in a corresponding period in 2019. Spontaneous resolution of mild appendicitis may have contributed to the increased proportion of patients with complicated appendicitis. Late presenting patients were older and experienced more postoperative complications compared to the control cohort.

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Unligature method of laparoscopic appendectomy in children

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic583 ◽

2020 ◽

Vol 10 (1) ◽

pp. 53-58

Author(s):

Vyacheslav G. Svarich ◽

Evgeniy G. Perevozchikov ◽

Ilya M. Kagantsov

Keyword(s):

Postoperative Complications ◽

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Open Appendectomy ◽

Operation Time ◽

High Energy ◽

Inflammatory Infiltration ◽

Surgical Department ◽

Clinical Hospital ◽

Digital Assessment

Aim. On the basis of the accumulated clinical material to show the possibility of a ligature-free method of laparoscopic appendectomy in children. Materials and methods. From 2000 to 2019, 2044 children with acute appendicitis were treated in the surgical department of the Republican childrens clinical hospital in Syktyvkar. Of these, 651 patients had an open appendectomy with treatment of the stump of the vermiform process by the submersible method, 1363 children had a laparoscopic appendectomy with ligature treatment of the stump of the process, and 32 patients had their first non-ligature laparoscopic appendectomy with the intersection of the vermiform process with the Ligasure device. Results. On average, surgery for ligature-free laparoscopic appendectomy lasted 7 3 minutes less than for laparoscopic appendectomy using the ligature method for treating the stump of the worm-like process. Experimentally, it was found that this method of appendectomy should not be used when the thickness of the worm-like process is more than 1.5 cm, with pronounced inflammatory infiltration of the caecum dome and perforation at the base of the process. With ligature-free appendectomy, the operation time was reduced. In the period from 1 to 6 months, there were no intra-abdominal postoperative complications associated with the new method of surgery. Conclusion. Ligar-free laparoscopic appendectomy in children using modern high-energy platforms with a digital assessment of the degree of tissue coagulation readiness made it possible to avoid intraoperative and postoperative complications, simplify the technique of its implementation, and reduce the time of surgery.

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Repair of Esophageal Atresia With Trache Esophageal Fistula Through Modified Transpleural Approach by Delivering Lung Out of Main Wound

Journal of Neonatology ◽

10.1177/0973217920921365 ◽

2018 ◽

Vol 32 (4) ◽

pp. 106-111

Author(s):

Pramod Kumar Mohanty ◽

Pravat Kumar Majumdar ◽

Hiranya Kishor Mohanty ◽

Pradeep Kumar Jena ◽

Prasant Kumar Tripathy ◽

...

Keyword(s):

Postoperative Complications ◽

Esophageal Atresia ◽

Tertiary Care ◽

Operation Time ◽

Anastomotic Site ◽

Care Hospital ◽

Co Morbidity ◽

Group 2 ◽

Surgery Department ◽

Approach Group

Objectives: To assess the morbidity, mortality, operation time, and postoperative complications in the present modified transpleural (MTP) approach with the conventional extrapleural (EP) approach in esophageal atresia (EA) with tracheoesophageal fistula (TEF). Design: Longitudinal randomized case control study. Setting: Pediatrics Surgery Department of a tertiary care hospital. Study period: November 2009 to December 2011. Participants: Neonates above 1.5 kg body weight with EA and TEF. Results: Sex ratio is 7:3 (male and female). In total, 40% had associate anomalies. Duration of operation in MTP approach from 90 to 110 min (mean duration 98.6 min) where as in EP approach from 120 to 130 min (mean duration 121.4 min). All 3(15% wound infections were in EP group. A total of 3 develops right sided pneumothorax with 2 in MTP and 1 in EP approach group. In total, 10% (2) in MTP approach group and 5% (1) in EP group expired. Leakage in anastomotic site was seen in 2(10%) each in both the groups. Six developed stricture, out of which 4 in EP group, 2 in MTP group. Conclusion: MTP approach is less time consuming, possess less hindrance during operation. Postoperative complications are comparable. Mortality is higher in MTP group than EP group, may be because of associated lethal co morbidity.

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Factors Affecting Length of Stay Following 3-Column Spinal Osteotomies in Pediatric Patients

Global Spine Journal ◽

10.1177/2192568219895225 ◽

2019 ◽

pp. 219256821989522

Author(s):

So Kato ◽

Taylor Dear ◽

Stephen J. Lewis

Keyword(s):

Body Weight ◽

Postoperative Complications ◽

Length Of Stay ◽

Pediatric Patients ◽

Perioperative Complications ◽

Intraoperative Complications ◽

Operation Time ◽

Fluid Administration ◽

Prolonged Stay ◽

Factors Affecting

Study Design: A retrospective analysis. Objectives: Length of stay (LOS) is one of the important indicators for the quality of patient care. Although perioperative complications are known to be associated with longer LOS in general, little has been understood regarding LOS after 3-column spinal osteotomy for the rigid spinal deformity in pediatric population. The main objective of the article is to identify factors affecting the LOS in pediatric patients undergoing 3-column posterior spinal osteotomies. Methods: Following research ethics approval, a retrospective review was performed of 35 consecutive posterior 3-column spinal osteotomies performed on pediatric patients in a single academic institution. Patients’ demographic data, preoperative comorbidities, details of operative procedures, intraoperative complications, and postoperative complications were investigated, and LOS was compared among the groups. Results: The mean LOS was 9.0 days, and the median LOS was 7 days (range = 4-23 days). Low body weight and syndromic deformity were associated with longer LOS. Operation time ≥6 hours and total perioperative fluid administration greater than or equal to twice the estimated blood volume were associated with longer LOS. Among postoperative complications, those with respiratory complication had prolonged stay. Conclusions: Preoperative low body weight and syndromic scoliosis had longer LOS after 3-column osteotomies. Excessive fluid administration and respiratory complications were associated with longer LOS.

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Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty

Hip International ◽

10.1177/1120700020975749 ◽

2020 ◽

pp. 112070002097574

Author(s):

Chapman Wei ◽

Alex Gu ◽

Arun Muthiah ◽

Safa C Fassihi ◽

Peter K Sculco ◽

...

Keyword(s):

Postoperative Complications ◽

Total Hip Arthroplasty ◽

Length Of Stay ◽

General Anaesthesia ◽

Hip Arthroplasty ◽

Postoperative Outcomes ◽

Complication Rates ◽

Total Hip ◽

Neuraxial Anaesthesia ◽

Extended Length

Background: As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the complexity of rTHA and the projected increase in incidence of these procedures, patient optimisation is becoming of interest to improve outcomes. Anaesthetic choice has been extensively studied in primary THA as a modifiable risk factor for postoperative outcomes, showing favourable results for neuraxial anaesthesia compared to general anaesthesia. The impact of anaesthetic choice in rTHA has not been studied previously. Methods: A retrospective study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent rTHA between 2014 and 2017 were divided into 3 anaesthesia cohorts: general anaesthesia, neuraxial anaesthesia, and combined general-regional (neuraxial and/or peripheral nerve block) anaesthesia. Univariate and multivariate analyses were used to analyse patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post-hoc analysis. Results: In total, 5759 patients were identified. Of these, 3551 (61.7%) patients underwent general anaesthesia, 1513 (26.3%) patients underwent neuraxial anaesthesia, and 695 (12.1%) patients underwent combined general-regional anaesthesia. On multivariate analysis, neuraxial anaesthesia was associated with decreased odds for any-one complication (OR 0.635; p < 0.001), perioperative blood transfusion (OR 0.641; p < 0.001), and extended length of stay (OR 0.005; p = 0.005) compared to general anaesthesia. Conclusions: Relative to those receiving general anaesthesia, patients undergoing neuraxial anaesthesia are at decreased risk for postoperative complications, perioperative blood transfusions, and extended length of stay. Prospective controlled trials should be conducted to verify these findings.

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Acute appendicitis in children in the context of the new coronavirus infection (COVID-19)

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2021-25-1-25-28 ◽

2021 ◽

Vol 25 (1) ◽

pp. 25-28

Author(s):

V. G. Svarich ◽

I. M. Kagantsov ◽

V. A. Svarich ◽

E. G. Perevozchikov

Keyword(s):

Postoperative Complications ◽

Acute Appendicitis ◽

Medical Care ◽

Surgical Care ◽

Komi Republic ◽

Complicated Appendicitis ◽

Surgical Department ◽

Results Of Treatment ◽

Significant Difference ◽

Coronavirus Infection

Introduction. The first publications about acute appendicitis in the conditions of the new COVID-19 coronavirus infection have appeared. Most authors point to the increased time of seeking medical help in such patients and an increase in the level of postoperative complications.Material and methods. A retrospective study of 192 case histories of patients aged 3 to 17 years with various forms of acute appendicitis who were treated in the surgical Department of the Republican children’s clinical hospital in the period from 2019 to November 2020 was conducted. Children operated on during 2019 before the start of the new coronavirus pandemic were included in the first group (n = 114). Children operated on in 2020 after the development of a new coronavirus pandemic were included in the second group (n = 78).Results. The age of patients in both groups compared did not differ significantly. The course of the disease was within the average accumulated indicators and the terms of hospitalization did not change significantly. According to our observations, the time of admission to the surgical hospital from the time of the disease in the pre-coronavirus period and during it also did not differ significantly, which indicates that the same availability of medical care remains even during the epidemic. Our study also showed that the number of requests for complicated appendicitis in children during the COVID-19 epidemic even decreased, which ultimately led to a decrease in the level of postoperative complications. The study did not establish a significant difference between the main results of treatment of children with acute appendicitis before and during the new COVID-19 coronavirus infection. Only the level of postoperative complications significantly decreased in patients operated during the COVID-19 epidemic, which is associated with a lower admission of children with complicated appendicitis.Conclusion. With the onset of the pandemic, the organization of medical care for the child population with acute pathology in the Komi Republic did not change and did not have any restrictions, which made it possible to maintain the timely provision of surgical care to children with acute appendicitis at the proper level.

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Surgical Outcomes of LigaSure Hemorrhoidectomy in the Elderly Population: A retrospective cohort study

BMC Gastroenterology ◽

10.1186/s12876-021-01969-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chuang-Wei Chen ◽

Tzung-Ju Lu ◽

Koung-Hung Hsiao

Keyword(s):

Cohort Study ◽

Postoperative Complications ◽

Surgical Outcomes ◽

Multivariate Logistic Regression Analysis ◽

Operation Time ◽

Admission Rate ◽

Complication Rates ◽

Time Duration ◽

Significant Difference ◽

Prone Jackknife Position

Abstract Background This study aims to assess the association between age and outcomes in patients undergoing hemorrhoidectomy. Methods This is a population-based cohort study. A retrospectively collected database with consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy between Jan. 2015 and May 2017 was reviewed. Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2). Both groups were compared regarding baseline characteristics and surgical outcomes. Results All patients tolerated the whole course of the operation in the prone jackknife position without anesthetic-associated complications. There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times. The multivariate logistic regression analysis that may contribute to postoperative complications revealed no significant difference for all complications between both groups. Conclusion The LigaSure hemorrhoidectomy for elderly patients is safe and effective without significant difference in short-term operative outcomes and all complication rates, compared with younger patients.

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Impact of COVID-19 Outbreak on the Emergency Presentation of Acute Appendicitis

The American Surgeon ◽

10.1177/0003134820972098 ◽

2020 ◽

Vol 86 (11) ◽

pp. 1508-1512

Author(s):

Mariana Kumaira Fonseca ◽

Eduardo N. Trindade ◽

Omero P. Costa Filho ◽

Miguel P. Nácul ◽

Artur P. Seabra

Keyword(s):

Postoperative Complications ◽

Length Of Stay ◽

Acute Appendicitis ◽

Symptom Onset ◽

Hospital Admissions ◽

Average Length ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Time Interval ◽

Emergency Presentation

Background The global crisis resulting from the coronavirus pandemic has imposed a large burden on health systems worldwide. Nonetheless, acute abdominal surgical emergencies are major causes for nontrauma-related hospital admissions and their incidences were expected to remain unchanged. Surprisingly, a significant decrease in volume and a higher proportion of complicated cases are being observed worldwide. Methods The present study assesses the local impact of the coronavirus pandemic on the emergency presentation of acute appendicitis in a Brazilian hospital. A retrospective analysis was conducted on patients undergoing emergency surgery for the clinically suspected diagnosis of acute appendicitis during the 2-month period of March and April 2020 and the same time interval in the previous year. Data on demographics, timing of symptom onset and hospital presentation, intraoperative details, postoperative complications, hospital length of stay, and histological examination of the specimen were retrieved from individual registries. Results The number of appendectomies during the pandemic was 36, which represents a 56% reduction compared to the 82 patients operated during the same period in 2019. The average time of symptom onset to hospital arrival was significantly higher in 2020 (40.6 vs. 28.2 hours, P = .02). The classification of appendicitis revealed a significant higher proportion of complicated cases than the previous year (33.3% vs. 15.2%, P = .04). The rate of postoperative complications and the average length of stay were not statistically different between the groups. Conclusion Further assessment of patients’ concerns and systematic monitoring of emergency presentations are expected to help us understand and adequately address this issue.

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Characteristics and Outcomes of Acute Appendicitis Cases During the COVID-19 Pandemic

10.21203/rs.3.rs-94523/v1 ◽

2020 ◽

Author(s):

Murat Başer ◽

Mehmet Kağan Katar

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Open Surgery ◽

Open Appendectomy ◽

Length Of Hospital Stay ◽

Operation Time ◽

Complication Rates ◽

Duration Of Symptoms ◽

Conversion To Open Surgery ◽

Group B

Abstract Background: Our aim in this study was to investigate the effects of the COVID-19 pandemic on acute appendicitis cases.Methods: This study was designed as a single-center, retrospective, and observational study. The patients were divided into three groups relative to the date of the first COVID-19 case in Turkey, which was March 10, 2020 (Group A: before the pandemic; Group B: pandemic period; Group C: the same period one year before the pandemic). A total of 413 patients were included in the study.Results: In terms of treatment modality, the rate of open appendectomy was significantly higher in group B (p<0.001). Rates of conversion to open surgery, as well as rates of complicated appendicitis were also significantly higher in group B (p=0.027, p=0.024, respectively). While there was no difference between the groups in terms of preoperative hospitalization duration (p=0.102), it was found that the duration of symptoms, operation time, and postoperative length of hospital stay were significantly higher in Group B (p<0.001, p=0.011, p=0.001, respectively). In addition, the complication rate in group B (8.9%) was also significantly higher than in the other two groups (p=0.023).Conclusion: We found that the rate of open surgery, the rate of conversion of laparoscopic surgery to open surgery, complication rates, mean operation time, and postoperative hospital stay were significantly higher in acute appendicitis patients that underwent surgery during the COVID-19 pandemic period. We believe that the main reason for this negative outcome is the late admission of the patients to the hospital.

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Are Preoperative CT Findings Useful for Predicting Postoperative Intraabdominal Abscess in the Patients with Acute Appendicitis?

10.20944/preprints201809.0590.v1 ◽

2018 ◽

Author(s):

Atsushi Kohga ◽

Kiyoshige Yajima ◽

Takuya Okumura ◽

Kimihiro Yamashita ◽

Jun Isogaki ◽

...

Keyword(s):

Acute Appendicitis ◽

Independent Predictor ◽

Univariate Analysis ◽

Operation Time ◽

Complicated Appendicitis ◽

Intraabdominal Abscess ◽

Ct Findings ◽

Free Air ◽

Preoperative Ct ◽

Ct Finding

Background: To investigate the preoperative clinical and radiological factors that predict the development of a postoperative intraabdominal abscess (IAA) in patients with acute appendicitis who were treated by laparoscopic appendectomy (LA). Methods: Two hundred sixteen patients with pathologically proven acute appendicitis underwent LA between January 2013 and March 2018 in our department. Of these, 147 patients were diagnosed with complicated appendicitis (CA) (CA group), while the other 69 patients were diagnosed with simple appendicitis (SA) (SA group). We compared the perioperative clinical and radiographic factors between the two groups and investigated the predictive factors of postoperative IAA. Results: Sixteen patients developed postoperative IAA in the CA group, while no patients did in the SA group. The univariate analysis revealed that time from onset to surgery more than 3 days (p = 0.011), the preoperative CT finding of periappendiceal fluid (p = 0.003), abscess (p < 0.001), and free air (p <0.001), operation time more than 120 minutes (p = 0.023) and placement of a drainage tube (p <0.001) were significantly associated with the development of IAA. Multivariate analysis revealed that the preoperative CT finding of free air was independently associated with the development of IAA (p = 0.007, odds ratio = 5.427). Conclusions: IAA was developed predominantly in the patients with CA. Preoperative CT findings of free air was found to be an independent predictor for the development of IAA. Surgeons should be meticulous in managing the postoperative course of patients with this finding.

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