Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital
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 (O...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12893-021-01231-1 |
| _version_ | 1818456454883966976 |
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| author | Heather C. M. Pringle Urszula Donigiewicz Melissa-Rose Bennett Eleanor Walker George E. Fowler Sunil Narang Susan Ball Robert M. Bethune |
| author_facet | Heather C. M. Pringle Urszula Donigiewicz Melissa-Rose Bennett Eleanor Walker George E. Fowler Sunil Narang Susan Ball Robert M. Bethune |
| author_sort | Heather C. M. Pringle |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T22:26:56Z |
| format | Article |
| id | doaj.art-7a4facbedb534cbd8a710fd53bbc4331 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-14T22:26:56Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-7a4facbedb534cbd8a710fd53bbc43312022-12-21T22:45:20ZengBMCBMC Surgery1471-24822021-05-012111610.1186/s12893-021-01231-1Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospitalHeather C. M. Pringle0Urszula Donigiewicz1Melissa-Rose Bennett2Eleanor Walker3George E. Fowler4Sunil Narang5Susan Ball6Robert M. Bethune7Royal Devon & Exeter HospitalRoyal Devon & Exeter HospitalRoyal Devon & Exeter HospitalRoyal Devon & Exeter HospitalRoyal Devon & Exeter HospitalRoyal Devon & Exeter HospitalNIHR Applied Research Collaboration, South West Peninsula (PenARC), University of Exeter Medical SchoolRoyal Devon & Exeter HospitalAbstract 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.https://doi.org/10.1186/s12893-021-01231-1AppendicitisCoronavirusGeneral Surgery |
| spellingShingle | Heather C. M. Pringle Urszula Donigiewicz Melissa-Rose Bennett Eleanor Walker George E. Fowler Sunil Narang Susan Ball Robert M. Bethune Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital BMC Surgery Appendicitis Coronavirus General Surgery |
| title | Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital |
| title_full | Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital |
| title_fullStr | Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital |
| title_full_unstemmed | Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital |
| title_short | Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital |
| title_sort | appendicitis during the covid 19 pandemic lessons learnt from a district general hospital |
| topic | Appendicitis Coronavirus General Surgery |
| url | https://doi.org/10.1186/s12893-021-01231-1 |
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