Changes in appendicitis treatment during the COVID-19 pandemic - A systematic review and meta-analysis

Franziska Köhler, Sophie Müller, Anne Hendricks, Carolin Kastner, Lena Reese, Kevin Boerner, Sven Flemming, Johan F Lock, Christoph-Thomas Germer, Armin Wiegering, Franziska Köhler, Sophie Müller, Anne Hendricks, Carolin Kastner, Lena Reese, Kevin Boerner, Sven Flemming, Johan F Lock, Christoph-Thomas Germer, Armin Wiegering

Abstract

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: A systematic literature search of Pubmed, Embase and Cochrane databases was performed, and eligible studies used to perform a meta-analysis.

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: 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.

Keywords: Antibiotic treatment; Appendicitis; COVID-19; Meta-analysis; SARS-CoV-2; Treatment.

Conflict of interest statement

The authors have no conflict of interest to declare.

Copyright © 2021 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the study identification and selection process.
Fig. 2
Fig. 2
Map of changes in appendicitis/appendectomy rates in adults. Green – reduction; blue – no change; red – increase; grey – no information available. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 3
Fig. 3
Change of appendicitis/appendectomy rates in during the COVID-19 pandemic compared to a similar time period before the onset of the pandemic.
Fig. 4
Fig. 4
A/B Forest plot of open appendectomies in adults (A) and children (B) before and during the onset of the pandemic.
Fig. 5
Fig. 5
A/B Forest plot of antibiotic treatment for AA before and during the pandemic in adults (A) and children (B).
Fig. 6
Fig. 6
A/B Forest plot of complicated appendicitis in adults (A) and children (B) before and after the onset of COVID-19.
Fig. 7
Fig. 7
A–D Length of hospital stay in days during and before the pandemic in adults (A) and children (B). Time from the beginning of symptoms until presentation in the emergency department in hours during and before the pandemic in adults (C) and children (D).

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