The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study.
Adult
Appendectomy
/ statistics & numerical data
Appendicitis
/ epidemiology
COVID-19
/ prevention & control
Cohort Studies
Communicable Disease Control
Female
Humans
Length of Stay
Male
Middle Aged
Pandemics
Postoperative Complications
/ epidemiology
Prospective Studies
SARS-CoV-2
United Kingdom
/ epidemiology
Antibiotics
Appendicectomy
Appendicitis
COVID-19
Non-operative
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
09
06
2020
accepted:
05
07
2020
pubmed:
17
7
2020
medline:
13
4
2021
entrez:
17
7
2020
Statut:
ppublish
Résumé
Acute appendicitis (AA) is the most common general surgical emergency. Early laparoscopic appendicectomy is the gold-standard management. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures: as a consequence, conservative management was advised, and open appendicectomy recommended when surgery was unavoidable. This study describes the impact of the first weeks of the pandemic on the management of AA in the United Kingdom (UK). Patients 18 years or older, diagnosed clinically and/or radiologically with AA were eligible for inclusion in this prospective, multicentre cohort study. Data was collected from 23rd March 2020 (beginning of the UK Government lockdown) to 1st May 2020 and included: patient demographics, COVID status; initial management (operative and conservative); length of stay; and 30-day complications. Analysis was performed on the first 500 cases with 30-day follow-up. The patient cohort consisted of 500 patients from 48 sites. The median age of this cohort was 35 [26-49.75] years and 233 (47%) of patients were female. Two hundred and seventy-one (54%) patients were initially treated conservatively; with only 26 (10%) cases progressing to an operation. Operative interventions were performed laparoscopically in 44% (93/211). Median length of hospital stay was significantly reduced in the conservatively managed group (2 [IQR 1-4] days vs. 3 [2-4], p < 0.001). At 30 days, complications were significantly higher in the operative group (p < 0.001), with no deaths in any group. Of the 159 (32%) patients tested for COVID-19 on admission, only 6 (4%) were positive. COVID-19 has changed the management of acute appendicitis in the UK, with non-operative management shown to be safe and effective in the short-term. Antibiotics should be considered as the first line during the pandemic and perhaps beyond.
Sections du résumé
BACKGROUND
Acute appendicitis (AA) is the most common general surgical emergency. Early laparoscopic appendicectomy is the gold-standard management. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures: as a consequence, conservative management was advised, and open appendicectomy recommended when surgery was unavoidable. This study describes the impact of the first weeks of the pandemic on the management of AA in the United Kingdom (UK).
METHODS
Patients 18 years or older, diagnosed clinically and/or radiologically with AA were eligible for inclusion in this prospective, multicentre cohort study. Data was collected from 23rd March 2020 (beginning of the UK Government lockdown) to 1st May 2020 and included: patient demographics, COVID status; initial management (operative and conservative); length of stay; and 30-day complications. Analysis was performed on the first 500 cases with 30-day follow-up.
RESULTS
The patient cohort consisted of 500 patients from 48 sites. The median age of this cohort was 35 [26-49.75] years and 233 (47%) of patients were female. Two hundred and seventy-one (54%) patients were initially treated conservatively; with only 26 (10%) cases progressing to an operation. Operative interventions were performed laparoscopically in 44% (93/211). Median length of hospital stay was significantly reduced in the conservatively managed group (2 [IQR 1-4] days vs. 3 [2-4], p < 0.001). At 30 days, complications were significantly higher in the operative group (p < 0.001), with no deaths in any group. Of the 159 (32%) patients tested for COVID-19 on admission, only 6 (4%) were positive.
CONCLUSION
COVID-19 has changed the management of acute appendicitis in the UK, with non-operative management shown to be safe and effective in the short-term. Antibiotics should be considered as the first line during the pandemic and perhaps beyond.
Identifiants
pubmed: 32671661
doi: 10.1007/s10151-020-02297-4
pii: 10.1007/s10151-020-02297-4
pmc: PMC7362319
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
401-411Investigateurs
H Javanmard-Emamghissi
(H)
H Boyd-Carson
(H)
M Hollyman
(M)
B Doleman
(B)
A Adiamah
(A)
J N Lund
(JN)
R Clifford
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L Dickerson
(L)
S Richards
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L Pearce
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J Cornish
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S Hare
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S Lockwood
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S J Moug
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G M Tierney
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Nikhil Kulkarni
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Isabel Pereira
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Sarah Barlow
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Sarannga Vanniasegaram
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Natalie S Blencowe
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Benjamin E Zucker
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Abigail Tyer
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Marianne Hollyman
(M)
Angeliki Kosti
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Thomas Badenoch
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Sarah Wheatstone
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Mariam Jaffer
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Hannah Gerretsen
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Rahul Menon
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Muhammad S Sajid
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Lauren Kennedy
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Sumit Sood
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Evonne Yu Wen Ng
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Vincent Ng
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Thomas Shortland
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Steven Brown
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Elizabeth Gemmill
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Hannah Boyd-Carson
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Nicola Reeves
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Issac Mayo
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Ezzat Chohda
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William Mccaughran
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Emma Beck
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Sowmya Garikipati
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Bryony E Lovett
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Bankole Oyewole
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(DFJ)
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Emanuele Gammeri
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Giulia Cillo
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Tania Magro
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Azzam Al-Amin
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Michael Thomas
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Gillian Tierney
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Hannah Javanmard-Emamghissi
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Carla Hope
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Arjun Gowda
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Dana Photiou
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Mari-Claire Mcguigan
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Norman Galbraith
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S K Richards
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D B Thompson
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Olaitan Babalola
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Kelvin Wang
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Commentaires et corrections
Type : ErratumIn
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