Acute appendicitis during the COVID-19 lockdown: never waste a crisis!

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Abstract

1. Whilst the number of Covid-19 cases increases, fewer patients present with appendicitis to the emergency department, and those who do, present with more advanced disease. 2. These findings are consistent with the hypothesis of a pre-hospital selection, with high rates of successful resolution of uncomplicated appendicitis following patients self-medication with antibiotics at home. 3. Patients admitted with suspected appendicitis during the pandemic are more likely to undergo preoperative imaging, which possibly explains the fall in negative appendectomy rate, especially in the UK.

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Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Changes in Clinical Presentation and CT Findings

Javier E. Romero, Sergio Valencia, Andrés Guerrero (2020)

Background Quarantine and stay-at-home orders are strategies that many countries used during the acute pandemic period of coronavirus disease 2019 (COVID-19) to prevent disease dissemination, health system overload, and mortality. However, there are concerns that patients did not seek necessary health care due to these mandates. Purpose To evaluate the differences in the clinical presentation of acute appendicitis and CT findings related to these cases between the COVID-19 acute pandemic period and nonpandemic period. Materials and Methods A retrospective observational study was performed to compare the acute pandemic period (March 23, 2020, to May 4, 2020) versus the same period the year before (March 23, 2019, to May 4, 2019). The proportion of appendicitis diagnosed by CT and level of severity of the disease were reviewed in each case. Univariate and bivariate analyses were performed to identify significant differences between the two groups. Results A total of 196 abdominal CT scans performed due to suspected acute appendicitis were evaluated: 55 from the acute pandemic period and 141 from the nonpandemic period. The proportion of acute appendicitis diagnosed by abdominal CT was higher in the acute pandemic period versus the nonpandemic period: 45.5% versus 29.8% (P = .038). The severity of the diagnosed appendicitis was higher during the acute pandemic period: 92% versus 57.1% (P = .003). Conclusion During the acute COVID-19 pandemic period, fewer patients presented with acute appendicitis to the emergency room, and those who did presented at a more severe stage of the disease.

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Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

A. Bhangu, D Nepogodiev, JH Matthews … (2019)

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified.

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Safe management of surgical smoke in the age of COVID-19

NG Mowbray, J ANSELL, J HORWOOD … (2020)

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M Podda:

ORCID: http://orcid.org/0000-0001-9941-0883

Journal

Journal ID (nlm-ta): Br J Surg

Journal ID (iso-abbrev): Br J Surg

Journal ID (publisher-id): bjs

Title: The British Journal of Surgery

Publisher: Oxford University Press

ISSN (Print): 0007-1323

ISSN (Electronic): 1365-2168

Publication date Collection: January 2021

Publication date (Electronic): 21 January 2021

Volume: 108

Issue: 1

Pages: e31-e32

Affiliations

[1 ] Department of Emergency Surgery, Cagliari University Hospital ‘Duilio Casula’, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari , Italy

[2 ] General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano , Italy

[3 ] La Sapienza University , Rome, Italy

[4 ] Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’ , Naples, Italy

[5 ] Colorectal Surgery, Vall d’Hebron University Hospital , Barcelona, Spain

[6 ] Unidad de Cirugia Hepatobiliopancreática, Hospital Universitario del Mar , Barcelona, Spain

[7 ] Department of General Surgery, University of Insubria, University Hospital of Varese, Azienda Socio-Sanitaria Territoriale (ASST) Sette Laghi , Regione Lombardia, Italy

Author notes

Correspondence to: Department of Emergency Surgery, Cagliari University Hospital ‘Duilio Casula’, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy (e-mail: mauropodda@ 123456ymail.com )

Author information

M Podda http://orcid.org/0000-0001-9941-0883

F Pata http://orcid.org/0000-0003-2634-1199

G Pellino http://orcid.org/0000-0002-8322-6421

B Ielpo http://orcid.org/0000-0003-3129-3208

Article

Publisher ID: znaa073

DOI: 10.1093/bjs/znaa073

PMC ID: 7929268

PubMed ID: 33640949

SO-VID: 86a90e08-852f-49e2-86e3-797328ce3895

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This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

History

Date received : 04 October 2020

Date accepted : 12 October 2020

Date: 11 October 2020

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Acute appendicitis during the COVID-19 lockdown: never waste a crisis!

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Most cited references 7

Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Changes in Clinical Presentation and CT Findings

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Safe management of surgical smoke in the age of COVID-19

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