Changes in appendicitis treatment during the COVID-19 pandemic - A systematic review and meta-analysis.
Antibiotic treatment
Appendicitis
COVID-19
Meta-analysis
SARS-CoV-2
Treatment
Journal
International journal of surgery (London, England)
ISSN: 1743-9159
Titre abrégé: Int J Surg
Pays: United States
ID NLM: 101228232
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
27
07
2021
revised:
12
09
2021
accepted:
18
10
2021
pubmed:
27
10
2021
medline:
23
11
2021
entrez:
26
10
2021
Statut:
ppublish
Résumé
During the COVID-19 pandemic in 2020 a decrease of emergency consultations and modification in treatment of numerous medical conditions were observed. Aim of this paper was to evaluate the effect of the COVID-19 pandemic on incidence, treatment strategies, severity, length of hospital stay and time of presentation in adults and children with acute appendicitis. A systematic literature search of Pubmed, Embase and Cochrane databases was performed, and eligible studies used to perform a meta-analysis. 46 suitable studies were identified with an overall reduction of appendicitis cases by 20.9% in adults and an increase of 13.4% in children. The rate of open appendectomies increased without statistical significance in both groups (adults: 8.5% vs. 7.1%, P = 0.32; children: 7.1% vs. 5.3%, P = 0.13), whereas the rate of antibiotic treatment increased significantly (P = 0.007; P = 0.03). Higher rates of complicated appendicitis were observed in adults (adults: OR 2.00, P < 0.0001; children: OR 1.64, P = 0.12). Time to first consultation did not change significantly (adults: 52.3 vs. 38.5 h - P = 0.057; children: 51.5 vs. 32.0 h - P = 0.062) and length of stay was also not lengthened during the pandemic (adults: 2.9 vs. 2.7 days, P = 0.057; children: 4.2 vs. 3.7 days, P = 0.062). The COVID-19 pandemic of 2020 had major impact on incidence and treatment strategies of acute appendicitis. Results of this meta-analysis might be another hint to support the theory that appendicitis is not a progressive disease and surgeons can safely consider antibiotic therapy for acute uncomplicated appendicitis.
Sections du résumé
BACKGROUND
BACKGROUND
During the COVID-19 pandemic in 2020 a decrease of emergency consultations and modification in treatment of numerous medical conditions were observed. Aim of this paper was to evaluate the effect of the COVID-19 pandemic on incidence, treatment strategies, severity, length of hospital stay and time of presentation in adults and children with acute appendicitis.
METHODS
METHODS
A systematic literature search of Pubmed, Embase and Cochrane databases was performed, and eligible studies used to perform a meta-analysis.
RESULTS
RESULTS
46 suitable studies were identified with an overall reduction of appendicitis cases by 20.9% in adults and an increase of 13.4% in children. The rate of open appendectomies increased without statistical significance in both groups (adults: 8.5% vs. 7.1%, P = 0.32; children: 7.1% vs. 5.3%, P = 0.13), whereas the rate of antibiotic treatment increased significantly (P = 0.007; P = 0.03). Higher rates of complicated appendicitis were observed in adults (adults: OR 2.00, P < 0.0001; children: OR 1.64, P = 0.12). Time to first consultation did not change significantly (adults: 52.3 vs. 38.5 h - P = 0.057; children: 51.5 vs. 32.0 h - P = 0.062) and length of stay was also not lengthened during the pandemic (adults: 2.9 vs. 2.7 days, P = 0.057; children: 4.2 vs. 3.7 days, P = 0.062).
CONCLUSION
CONCLUSIONS
The COVID-19 pandemic of 2020 had major impact on incidence and treatment strategies of acute appendicitis. Results of this meta-analysis might be another hint to support the theory that appendicitis is not a progressive disease and surgeons can safely consider antibiotic therapy for acute uncomplicated appendicitis.
Identifiants
pubmed: 34700020
pii: 01279778-202111000-00030
doi: 10.1016/j.ijsu.2021.106148
pmc: PMC8539829
doi:
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
106148Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
Références
Snyder Matthew J. Marjorie guthrie, staphem cagle, acute appendicitis: efficient diagnosis and management. Am. Fam. Physician . 2018;98:25-33.
Bhangu A, Sφreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet . 2015;386:1278-1287.
The Coda Collaborative. A randomized trial comparing antibiotics with appendectomy for appendicitis. N. Engl. J. Med. 2020, NEJMoa2014320. http://dx.doi.org/10.1056/NEJMoa2014320
Poillucci G, Mortola L, Podda M, Di Saverio S, Casula L, Gerardi C, Cillara N, Presenti L, Balestra F, Serventi F, Fiume S, D Lai MA, Ledda S, Pulighe F, Gobbi S, De Nisco C, Argenio G, Norcia G, Gemini S, Sechi R, Pala M, Pau R, Ottonello R, Pisano M, Aresu S, Coppola M, Tuveri A, Madeddu F, Piredda A, Pinna G, Scognamillo F, Tilocca PL, Delogu L, Carboni GM, Porcu G, Piras D. Laparoscopic appendectomy vs antibiotic therapy for acute appendicitis: a propensity score-matched analysis from a multicenter cohort study. Updates Surg . 2017;69:531-540. http://dx.doi.org/10.1007/s13304-017-0499-8 .
Harnoss JC, Zelienka I, Probst P, Grummich K, Müller-Lantzsch C, Harnoss JM, Ulrich A, Büchler MW, Diener MK. Antibiotics versus surgical therapy for uncomplicated appendicitis: systematic review and meta-analysis of controlled trials (PROSPERO 2015:CRD42015016882). Ann. Surg . 2017;265:889-900. http://dx.doi.org/10.1097/SLA.0000000000002039 .
Wilms IM, de Hoog DE, de Visser DC, Janzing HM. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst. Rev . 2011;11: http://dx.doi.org/10.1002/14651858.cd008359.pub2 .
Sohrabi C, Alsafi Z, Neill NO, Khan M, Kerwan A. World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19). Int. J. Surg . 2020;76:71-76.
Li X, Xu Z, Wang T, Xu X, Li H, Sun Q, Zhou X. Clinical laboratory characteristics of severe patients with coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis Xiang. Clin. Epidemiol. Glob. Heal . 2020;9:184-190.
WHO Coronavirus Disease (COVID-19). Dashboard. (n.d.) https://covid19.who.int/ . accessed March 4, 2021.
Flemming S, Hankir M, Ernestus RI, Seyfried F, Germer CT, Meybohm P, Wurmb T, Vogel U, Wiegering A. Surgery in times of COVID-19—recommendations for hospital and patient management. Langenbeck’s Arch. Surg . 2020;405:359-364.
English W, Habib Bedwani N, Smith C, Doganay E, Marsden M, Muse S, Mak WK, Chana M, Eves J, Shatkar V. Suspected appendicitis and COVID-19, a change in investigation and management—a multicentre cohort study. Langenbeck’s Arch. Surg . 2020;406:357-365. http://dx.doi.org/10.1007/s00423-020-02023-6 .
Slagman A, Behringer W, Greiner F, Klein M, Weismann D, Erdmann B, Pigorsch M, Möckel M. Medizinische Notfälle während der COVID-19-Pandemie. Dtsch. Arztebl. Int . 2020;117:545-552.
Dick L, Green J, Brown J, Kennedy E, Cassidy R, Othman S, Berlansky M. Changes in emergency general surgery during covid-19 in scotland: a prospective cohort study. World J. Surg . 2020;44:3590-3594. http://dx.doi.org/10.1007/s00268-020-05760-3 .
Page Mj MD, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tr. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int. J. Surg . 2021;88:
Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP, Robins -I. A tool for assessing risk of bias in non-randomised studies of interventions. BMJ . 2016;355:4-10. http://dx.doi.org/10.1136/bmj.i4919 .
Baral S, Chhetri RK, Thapa N. Comparison of acute appendicitis before and within lockdown period in COVID-19 era: a retrospective study from rural Nepal. PLoS One . 2021;16:e0245137. http://dx.doi.org/10.1371/journal.pone.0245137 .
Baugh JJ, White BA, Mcevoy D, Yun BJ. The cases not seen: patterns of emergency department visits and procedures in the era of COVID-19. Am. J. Emerg. Med . 2020;46:476-481.
Boyle LI, Boyle A, Jay S, Marnewick J. COVID-19 lockdown impact on common general surgical acute presentations to a regional centre in New Zealand. N. Z. Med. J . 2020;133:96-105.
Butt A, Kartha A, Masoodi N, Azad A, Asaad N, Alhomsi M, Saleh H, Bertolli R, Abou-Samra A-B. Hospital Admission Rates, Length of Stay and In-Hospital Mortality for Common Acute Care Conditions in COVID-19 vs. Pre-COVID-19 Era Adeel. 2020, Public Health. http://dx.doi.org/10.4213/sm1362
Drysdale HRE, Ooi S, Nagra S, Watters DA, Guest GD, Anderson W, Asgill T, Bernadi P, Bowden E, Cole J, Crowley S, Dangen J, Drysdale H, Guest G, Lau S, Leang Y, McMahon E, Mary Moore E, Nagra S, Ooi S, Othman B, Pellegrino S, Shears M, Stupart D, Underwood K, Watters D. Clinical activity and outcomes during Geelong’s general surgery response to the coronavirus disease 2019 pandemic. ANZ J. Surg . 2020;90:1573-1579. http://dx.doi.org/10.1111/ans.16207 .
Fallani G, Lombardi R, Masetti M, Chisari M, Zanini N, Cattaneo GM, Filosa M, Zanzi F, Guerra E, Bonilauri S, Di Donato L, Garulli G, Lucchi A, Grassia M, Ugolini G, Pasini F, Vetrone G, Benini C, Nicosia S, Jovine E. Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis. Updates Surg. 2021, 753-762. http://dx.doi.org/10.1007/s13304-020-00943-y
Guadalajara H, Muñoz de Nova JL, Fernandez Gonzalez S, Yiasemidou M, Recarte Rico M, Juez LD, García Septiem J, Galindo Jara P, García Virosta M, Lobo Martínez E, Martín-Pérez E, García-Olmo D, Fernández-Cebrián JM, Blazquez Martin A, Jover JM, Iparraguirre MA, Acín-Gándara D, Perea-del-Pozo E, Dios-Barbeito S, Martin-Antona E, Durán-Poveda M, Peinado Iribar B, Moreno Elola-Olaso A, Pascual Migueláñez I, Gortázar de las Casas S, Paseiro Crespo G, Pardo R, Fernández Luengas D, Garcia Chiloeches A, Puerta A, Maqueda González R, Gutiérrez Samaniego M, Colao García L, Serrano González J, Núñez O’Sullivan S, Rodriguez Haro C, Vaquero MA, Nieto AP, Vera-Mansilla C, Pérez-González M, Soto Schütte S, Gutiérrez Calvo A, Sanchez Argüeso A, Hernández-Villafranca S, Qian Zhang S, Gorosabel M, Mínguez García J, Casalduero García L, Florez Gamarra M, Arguello Andres JM, Tallon Iglesias B, García Gutierrez V, Pereira Perez F, Aparicio-Sanchez D, Durán-Muñoz-Cruzado V, Pareja-Ciuró F, Cano-Valderrama O, Avellana R, Torres-Garcia AJ, Zarain Obrador L, Fernandez Luengas D, Garcia Ureña MA, Toribio Vazquez C, Fuenmayor-Valera ML. Patterns of acute surgical inflammatory processes presentation of in the COVID-19 outbreak (PIACO Study): surgery may be the best treatment option. Br. J. Surg . 2020;107:e494-e495. http://dx.doi.org/10.1002/bjs.11950 .
Köhler F, Acar L, van den Berg A, Flemming S, Kastner C, Müller S, Diers J, Germer CT, Lock JF, L’hoest H, Marschall U, Wiegering A. Impact of the COVID-19 pandemic on appendicitis treatment in Germany—a population-based analysis. Langenbeck’s Arch. Surg. 2021, 377-383. http://dx.doi.org/10.1007/s00423-021-02081-4
Kumaira Fonseca M, Trindade EN, Costa Filho OP, Nácul MP, Seabra AP. Impact of COVID-19 outbreak on the emergency presentation of acute appendicitis. Am. Surg . 2020;86:1508-1512. http://dx.doi.org/10.1177/0003134820972098 .
Lechner D, Tschann P, Girotti PCN, Königsrainer I. Impact of the COVID-19 Pandemic on a Visceral Surgical Department in Western Austria. 2020, Eur. Surg. - Acta Chir. Austriaca. http://dx.doi.org/10.1007/s10353-020-00683-8
Maneck M, Günster C, Meyer HJ, Heidecke CD, Rolle U. Influence of COVID-19 confinement measures on appendectomies in Germany—a claims data analysis of 9797 patients. Langenbeck’s Arch. Surg. 2020, 385-391. http://dx.doi.org/10.1007/s00423-020-02041-4
McGuinness MJ, Harmston C. The effect of national public health interventions for COVID-19 on emergency general surgery in Northland, New Zealand. ANZ J. Surg. 2021, 329-334. http://dx.doi.org/10.1111/ans.16562
McGuinness MJ, Hsee L. Impact of the COVID-19 national lockdown on emergency general surgery: auckland City Hospital’s experience. ANZ J. Surg . 2020;90:2254-2258. http://dx.doi.org/10.1111/ans.16336 .
Mekaeil V, Wiener D, Silverman M, Miller I, Dittus E, Eskin B, Allegra J. Emergency department visits for serious and painful conditions markedly decreased after the arrival of COVID-19. Ann. Emerg. Med . 2020;76: http://dx.doi.org/10.1088/1751-8113/44/8/085201 .
Meriç S, Vartanoglu Aktokmakyan T, Tokocin M, Aktimur YE, Hacım NA, Gülcicek OB. Akut apandisit yönetiminin normal dönemde ve COVID-19 pandemisi esnasında karşılaştırmalı analizi, Ulus. Travma Acil Cerrahi Derg . 2020;27:22-25. http://dx.doi.org/10.14744/tjtes.2020.46487 .
Patel VK, Ye K, In H, Scheinfeld MH. Non-operative management for acute appendicitis during the COVID-19 pandemic does not increase the rate of complications. J. Gastrointest. Surg. 2020, 10-12. http://dx.doi.org/10.1007/s11605-020-04844-8
Rosa F, Covino M, Sabia L, Quero G, Fiorillo C, Cozza V, Sganga G, Gasbarrini A, Franceschi F, Alfieri S. Surgical emergencies during SARS-CoV-2 pandemic lockdown: what happened? Eur. Rev. Med. Pharmacol. Sci . 2020;24:11919-11925. http://dx.doi.org/10.26355/eurrev_202011_23851 .
Romero J, Valencia S, Guerrero A. Acute appendicitis during coronavirus disease 2019 (COVID-19): changes in clinical presentation and CT findings. J. Am. Coll. Radiol . 2020;17:1011-1013. http://dx.doi.org/10.1016/j.jacr.2020.06.002 .
Surek A, Ferahman S, Gemici E, Dural AC, Donmez T, Karabulut M. Effects of COVID-19 pandemic on general surgical emergencies: are some emergencies really urgent? Level 1 trauma center experience. Eur. J. Trauma Emerg. Surg. 2020, 647-652. http://dx.doi.org/10.1007/s00068-020-01534-7
Tankel J, Keinan A, Blich O, Koussa M, Helou B, Shay S, Zugayar D, Pikarsky A, Mazeh H, Spira R, Reissman P. The decreasing incidence of acute appendicitis during COVID-19: a retrospective multi-centre study. World J. Surg . 2020;44:2458-2463. http://dx.doi.org/10.1007/s00268-020-05599-8 .
Turanli S, Kiziltan G. Did the COVID-19 pandemic cause a delay in the diagnosis of acute appendicitis? World J. Surg . 2021;45:18-22. http://dx.doi.org/10.1007/s00268-020-05825-3 .
Verma S, Garg P, Verma A, Sirohi V. Careful non-operative management with surveillance of acute appendicitis during COVID-19 pandemic. Indian J. Surg. 2020, 4-5. http://dx.doi.org/10.1007/s12262-020-02620-1
Walker LE, Heaton HA, Monroe RJ, Reichard RR, Kendall M, Mullan AF, Goyal DG. Impact of the SARS-CoV-2 pandemic on emergency department presentations in an integrated health system. Mayo Clin. Proc . 2020;95:2395-2407. http://dx.doi.org/10.1016/j.mayocp.2020.09.019 .
Perrone G, Guiffrida M, Bonati E, Del Rio P, Pattonieri V, Tarasconi A, Coccolini F, Sartelli M, Ansaloni L, Catena F. Emergenxy surgery in A tertiary hospital: the COVID-19 experience, Bangladesh. J. Med. Sci . 2020;19:66-68.
Zhou Y, Cen LS. Managing acute appendicitis during the COVID-19 pandemic in Jiaxing, China, World. J. Clin. Cases . 2020;8:4349-4359. http://dx.doi.org/10.12998/wjcc.v8.i19.4349 .
Finkelstein P, Picado O, Muddasani K, Wodnicki H, Mesko T, Unger S, Bao P, Jorge I, Narayanan S, Ben-David K. A retrospective analysis of the trends in acute appendicitis during the COVID-19 pandemic. J. Laparoendosc. Adv. Surg. Tech. 2020, 1-4. http://dx.doi.org/10.1089/lap.2020.0749 00
Lee-Archer P, Blackall S, Campbell H, Boyd D, Patel B, McBride C. Increased incidence of complicated appendicitis during the COVID-19 pandemic. J. Paediatr. Child Health . 2020;56:1313-1314. http://dx.doi.org/10.1111/jpc.15058 .
Montalva L, Haffreingue A, Ali L, Clariot S, Julien-Marsollier F, El Ghoneimi A, Peycelon M, Bonnard A. The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak. Pediatr. Surg. Int . 2020;36:1397-1405. http://dx.doi.org/10.1007/s00383-020-04759-0 .
Snapiri O, Rosenberg Danziger C, Krause I, Kravarusic D, Yulevich A, Balla U, Bilavsky E. Delayed diagnosis of paediatric appendicitis during the COVID-19 pandemic. Acta Paediatr. Int. J. Paediatr . 2020;109:1672-1676. http://dx.doi.org/10.1111/apa.15376 .
La Pergola E, Sgrò A, Rebosio F, Vavassori D, Fava G, Codrich D, Montanaro B, Leva E, Schleef J, Cheli M, Pelizzo G, Gamba P, Alberti D, Betalli P. Appendicitis in children in a large Italian COVID-19 pandemic area. Front. Pediatr . 2020;8:1-5. http://dx.doi.org/10.3389/fped.2020.600320 .
Raffaele A, Cervone A, Ruffoli M, Cereda E, Avolio L, Parigi GB, Riccipetitoni G. Critical factors conditioning the management of appendicitis in children during COVID-19 Pandemic: experience from the outbreak area of Lombardy, Italy. Br. J. Surg . 2020;107:e529-e530. http://dx.doi.org/10.1002/bjs.12004 .
Bada-Bosch I, de Agustín JC, de la Torre M, Ordóñez J, Blanco MD, Pérez-Egido L, Fanjul M, Del Cañizo A. Pediatric surgical activity during the SARS-CoV-2 pandemic: experience at a tertiary hospital. Cir. Pediatr . 2021;34:28-33. http://www.ncbi.nlm.nih.gov/pubmed/33507641 .
Sheath C, Abdelrahman M, MacCormick A, Chan D. Paediatric appendicitis during the COVID-19 pandemic. J. Paediatr. Child Health. 2021, 986-989. http://dx.doi.org/10.1111/jpc.15359
Fisher JC, Tomita SS, Ginsburg HB, Gordon A, Walker D, Kuenzler KA. Increase in Pediatric Perforated Appendicitis in the New York City Metropolitan Region at the Epicenter of the COVID-19 Outbreak. 2020, Ann. Surg. Publish Ah. http://dx.doi.org/10.1097/sla.0000000000004426
Gerall CD, Defazio JR, Kahan AM, Fan W, Fallon EM, Middlesworth W, Stylianos S, Zitsman JL, V Kadenhe-chiweshe A, Spigland NA, Griggs CL, Kabagambe SK, Apfel G, Fenster DB, Duron VP. Delayed presentation and sub-optimal outcomes of pediatric patients with acute appendicitis during the COVID-19 pandemic. J. Pediatr. Surg. 2020;905-910.
Pines JM, Zocchi MS, Black BS, Carlson JN, Celedon P, Moghtaderi A, Venkat A. Characterizing pediatric emergency department visits during the COVID-19 pandemic. Am. J. Emerg. Med. 2020, 11-14. http://dx.doi.org/10.1016/j.ajem.2020.11.037
Place R, Lee J, Howell J. Rate of pediatric appendiceal perforation at a children’s hospital during the COVID-19 pandemic compared with the previous year. JAMA Netw. Open . 2020;3:e2027948. http://dx.doi.org/10.1001/jamanetworkopen.2020.27948 .
Ganesh R, Lucocq J, Ekpete NO, Ain NU, Lim SK, Alwash A, Bibi S, Alijani A. Management of appendicitis during COVID-19 pandemic; short-term outcomes. Scot. Med. J . 2020;65:144-148. http://dx.doi.org/10.1177/0036933020956316 .
Orthopoulos G, Santone E, Izzo F, Tirabassi M, Pérez-Caraballo AM, Corriveau N, Jabbour N. Increasing incidence of complicated appendicitis during COVID-19 pandemic. Am. J. Surg. 2020;1056-1060.
Toale C, Westby D, O’Callaghan M, Nally D, Burke P, Peirce C, Coffey JC, Cunningham RM. Appendicitis and the COVID pandemic; new challenges in the management of a familiar foe. Br. J. Surg . 2020;107:e605-e606. http://dx.doi.org/10.1002/bjs.12058 .
Wang AW, Prieto J, Ikeda DS, Lewis PR, Benzer EM, Van Gent J-M. Perforated appendicitis: an unintended consequence during the coronavirus-19 pandemic. Mil. Med . 2020;186: http://dx.doi.org/10.1093/milmed/usaa527 .
Angeramo CA, Dreifuss NH, Schlottmann F, Rotholtz NA. More severe presentations of acute appendicitis during COVID-19. J. Gastrointest. Surg. 2021, 10-12. http://dx.doi.org/10.1007/s11605-020-04892-0
Dreifuss NH, Schlottmann F, Sadava EE, Rotholtz NA. Acute appendicitis does not quarantine: surgical outcomes of laparoscopic appendectomy in COVID-19 times. Br. J. Surg . 2020;107:e368-e369. http://dx.doi.org/10.1002/bjs.11806 .
Gao Z, Li M, Zhou H, Liang Y, Zheng C, Li S, Zhang T, Deng W, Boyle LI, Boyle A, Jay S, Marnewick J, Widemier P, Orthopoulos G, Santone E, Izzo F, Tirabassi M, Pérez-Caraballo AM, Corriveau N, Jabbour N, Romero J, Valencia S, Guerrero A, Walker LE, Heaton HA, Monroe RJ, Reichard RR, Kendall M, Mullan AF, Goyal DG. Complicated appendicitis are common during the epidemic period of 2019 novel coronavirus (2019-nCoV). Asian J. Surg. J . 2020;17:2395-2407. http://dx.doi.org/10.1016/j.jacr.2020.06.002 .
Bellini T, Rotulo G, Carlucci M, Fiorenza V, Piccotti E, Mattioli G. Complicated appendicitis due to diagnosis delay during lockdown period in Italy. Acta Paediatr. 2021, 1-2. http://dx.doi.org/10.1111/apa.15756
Cook TM, Lennane S. Occupational COVID-19 risk for anaesthesia and intensive care staff – low-risk specialties in a high-risk setting. Anaesthesia . 2021;76:295-300. http://dx.doi.org/10.1111/anae.15358 .
Parcha V, Booker KS, Kalra R, Kuranz S, Berra L. OPEN A retrospective cohort study patients in the United States. Sci. Rep. 2021, 1-10. http://dx.doi.org/10.1038/s41598-021-89553-1
Royal College of Surgeons. (n.d.) https://www.rcseng.ac.uk/coronavirus/joint-guidance-for-surgeons-v2/ . accessed April 18, 2021.
de Simone B, Chouillard E, Di Saverio S, Pagani L, Sartelli M, Biffl WL, Coccolini F, Pieri A, Khan M, Borzellino G, Campanile FC, Ansaloni L, Catena F. Emergency surgery during the COVID-19 pandemic: what you need to know for practice. Ann. R. Coll. Surg. Engl . 2020;102:323-332. http://dx.doi.org/10.1308/RCSANN.2020.0097 .
Flemming S, Hankir M, Hering I, Meybohm P, Krone M, Weissbrich B, Germer CT, Wiegering A. Abdominal fluid samples (negative for SARS-CoV-2) from a critically unwell patient with respiratory COVID-19. Br. J. Surg . 2020;107:e259-e260. http://dx.doi.org/10.1002/bjs.11713 .
Singh D, Yi SV. On the origin and evolution of SARS-COV-2. Exp. Mol. Med. 2021, 537-547. http://dx.doi.org/10.1088/1367-2630/15/10/103012
Ranney ML, Griffeth V, Jha AK. Critical supply shortages — the need for ventilators and personal protective equipment during the covid-19 pandemic. N. Engl. J. Med. 2020;382(1–3):e41, nejm.org.