Has the Pandemic Changed Management of Acute Appendicitis?

Pavankumar Kamat

September 20, 2021

A new study suggests that the use of cross-sectional imaging and conservative management in confirmed cases of acute appendicitis in the UK may have increased in the COVID-19 era. Furthermore, greater reliance on imaging may have resulted in fewer negative appendectomies.

Acute appendicitis is of the most common medical emergencies, which is primarily managed with laparoscopic appendicectomy. The COVID-19 pandemic resulted in several restrictions in emergency and elective surgical services in the UK. The use of laparoscopic surgery was particularly restricted owing to the risk of aerosol generation. As a result, many surgical conditions managed in the emergency setting had to be re-evaluated.

A retrospective study evaluated the management of patients with suspected acute appendicitis at a single hospital in the UK, who were categorised into pre-COVID-19 (n=82) and post-COVID-19 (n=79) cohorts using 18 March 2020 as the cut-off date.

In the pre-COVID-19 group, 67.07% of the patients underwent appendicectomy, whereas the remaining were managed conservatively using antibiotics. In contrast, only 22.78% (P=.013) of patients in the post-COVID-19 group underwent appendicectomy.

Fewer patients in the pre-COVID-19 cohort underwent a CT scan as part of the diagnostic workup than in the post-COVID-19 group (24.4% vs 54.4%; P<.001). Compared with the pre-COVID-19 group, significantly fewer patients in the post-COVID-19 group had a histologically normal appendix removed (12.7% vs 0.0%; P=.001).

Among patients who underwent appendicectomy, the median delay to surgery and the median length of hospital stay were comparable between the groups. The rate of complications among surgically managed patients was higher in the pre-COVID-19 vs post-COVID-19 group (25.45% vs 16.66%). None of the patients with confirmed appendicitis managed conservatively required surgical intervention within a 30-day follow-up period.

Writing in the  Journal of Multidisciplinary Healthcare,  the authors stated: "This study is an important contribution to demonstrate the impact of COVID19 on management of appendicitis and the service adjustments that have been required."

The study did not receive any funding. The authors reported no conflict of interest.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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