Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital

Springer Science and Business Media LLC - Tập 21 Số 1 - 2021
Heather Pringle1, Urszula Donigiewicz1, Melissa-Rose Bennett1, Eleanor Walker1, George E Fowler1, Sunil K. Narang1, Susan Ball2, Robert Bethune3
1Royal Devon & Exeter Hospital, Exeter, EX2 5DW, Devon, UK
2NIHR Applied Research Collaboration, South West Peninsula (PenARC), University of Exeter Medical School, Exeter, EX1 2LU, Devon, UK
3University of Exeter Medical School, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, Devon, UK

Tóm tắt

Abstract Background The COVID-19 pandemic dramatically influenced the delivery of healthcare. In line with the UK Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy when operative management (OM) was sought. We describe our experience of the presentation, management and outcomes for these patients to inform care for future viral pandemics. Methods This retrospective, cohort study compared patients diagnosed with AA between March and July 2019 with those during the pandemic period of March to July 2020. Medical records were reviewed to obtain demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS) and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohorts respectively. 14 patients (9.4%) had NOM in 2019 versus 31 (24.8%) in 2020 (p = 0.001). In the 2019 operative management (OM) group 125 patients (92.6%) had laparoscopic appendicectomy versus 65 (69.1%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days in 2019 and 3 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 received OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one tested 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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