TY - JOUR
T1 - Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis
T2 - a comparison between 2019 and 2020
AU - Scheijmans, Jochem C. G.
AU - Borgstein, Alexander B. J.
AU - Puylaert, Carl A. J.
AU - Bom, Wouter J.
AU - Bachiri, Said
AU - van Bodegraven, Eduard A.
AU - Brandsma, Amarins T. A.
AU - ter Brugge, Floor M.
AU - de Castro, Steve M. M.
AU - Couvreur, Roy
AU - Franken, Lotte C.
AU - Gaspersz, Marcia P.
AU - de Graaff, Michelle R.
AU - Groenen, Hannah
AU - Kleipool, Suzanne C.
AU - Kuypers, Toon J. L.
AU - Martens, Milou H.
AU - Mens, David M.
AU - Orsini, Ricardo G.
AU - Reneerkens, Nando J. M. M.
AU - Schok, Thomas
AU - Sedee, Wouter J. A.
AU - Tavakoli Rad, Shahzad
AU - Volders, Jose H.
AU - Weeder, Pepijn D.
AU - Prins, Jan M.
AU - Gietema, Hester A.
AU - Stoker, Jaap
AU - Gisbertz, Suzanne S.
AU - Besselink, Marc G. H.
AU - Boermeester, Marja A.
AU - SCOUT Collaboarative Study group
PY - 2021/5/12
Y1 - 2021/5/12
N2 - 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.
AB - 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.
KW - Acute appendicitis
KW - COVID-19 pandemic
KW - Complicated appendicitis
KW - COMPLICATED APPENDICITIS
KW - NATURAL-HISTORY
KW - SURGERY
KW - METAANALYSIS
KW - DIAGNOSIS
KW - COMMON
U2 - 10.1186/s12873-021-00454-y
DO - 10.1186/s12873-021-00454-y
M3 - Article
C2 - 33980150
SN - 1471-227X
VL - 21
JO - BMC Emergency Medicine
JF - BMC Emergency Medicine
IS - 1
M1 - 61
ER -