The decrease of non-complicated acute appendicitis and the negative appendectomy rate during pandemic

Marco Ceresoli, Federico Coccolini, Stefano Magnone, Alessandro Lucianetti, Pietro Bisagni, Teodora Armao, Luca Ansaloni, Mauro Zago, Massimo Chiarugi, Fausto Catena, Marco Braga, Appendicitis-COVID study group, Marco Nizzardo, Luca Nespoli, Luca Fattori, Luca Degrate, Stefano Perrone, Marco Cereda, Michele Pisano, Elia Poiasina, Paolo Bertoli, Michele Ballabio, Stefano Braga, Giorgio Graziano, Dario Tartaglia, Francesco Arces, Marco Mariani, Fulvio Tagliabue, Gennaro Perrone, Alfredo Annicchiarico, Mario Giuffrida, Giovanni Ferrari, Antonio Benedetti, Niccolò Allievi, Michele Ciocca, Enrico Pinotti, Mauro Montuori, Michele Carlucci, Valentina Tomajer, Paola Fugazzola, Marco Ceresoli, Federico Coccolini, Stefano Magnone, Alessandro Lucianetti, Pietro Bisagni, Teodora Armao, Luca Ansaloni, Mauro Zago, Massimo Chiarugi, Fausto Catena, Marco Braga, Appendicitis-COVID study group, Marco Nizzardo, Luca Nespoli, Luca Fattori, Luca Degrate, Stefano Perrone, Marco Cereda, Michele Pisano, Elia Poiasina, Paolo Bertoli, Michele Ballabio, Stefano Braga, Giorgio Graziano, Dario Tartaglia, Francesco Arces, Marco Mariani, Fulvio Tagliabue, Gennaro Perrone, Alfredo Annicchiarico, Mario Giuffrida, Giovanni Ferrari, Antonio Benedetti, Niccolò Allievi, Michele Ciocca, Enrico Pinotti, Mauro Montuori, Michele Carlucci, Valentina Tomajer, Paola Fugazzola

Abstract

Background: During pandemic, admissions for surgical emergencies dropped down dramatically. Also acute appendicitis decreased. The aim of the present study was to evaluate the change in volume and clinical presentation of patients with acute appendicitis during pandemic and the variation in treatment.

Methods: This is a retrospective study of patients admitted in 11 Italian hospital for acute appendicitis during the lockdown period (March-April 2020) compared with the same period of the previous 2 years (2018-2019). The number and the rate of complicated and non-complicated acute appendicitis were recorded and compared between the two study periods; non-operative vs operative treatment and negative appendectomy rate were also recorded.

Results: The study included 532 patients, 112 in the study period and 420 in the control period; Hospital admission for acute appendicitis dropped by 46% (OR 0.516 95% CI 0.411-0.648 p < 0.001) during the 2020 lockdown. The number of complicated acute appendicitis did not change (- 18%, OR 0.763 95% CI 0.517-1.124 p = 0.1719), whereas the number of non-complicated acute appendicitis significantly decreased (- 56%, OR 0.424 95% CI 0.319-0.564 p < 0.001). Non-operative treatment rate remained similar (12.1% vs. 11.6% p = 0.434). The negative appendectomy rate also significantly decreased (6.1% vs. 17.3%, p = 0.006).

Conclusions: The present study found a significant reduction of both admissions for non-complicated acute appendicitis and negative appendectomy rate during the pandemic period. Conversely, admissions for complicated acute appendicitis did not change.

Trial registration: NCT04649996.

Keywords: Acute appendicitis; COVID-19; Non-complicated acute appendicitis.

Conflict of interest statement

All the authors have no conflict of interest to declare.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Included study centers with local prevalence of SARS-CoV2 infections
Fig. 2
Fig. 2
Number of non-complicated and complicated acute appendicitis during the study periods
Fig. 3
Fig. 3
Linear correlation between prevalence of SARS-CoV2 infection and % change in hospital admission due to acute appendicitis

References

    1. Livingston E, Vons C. Treating appendicitis without surgery. JAMA - J Am Med Assoc. 2015;313(23):2327–2328. doi: 10.1001/jama.2015.6266.
    1. Ferris S, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg. 2017;266:237–41. doi: 10.1097/SLA.0000000000002188.
    1. Ceresoli M, Zucchi A, Allievi N, Harbi A, Pisano M, Montori G, et al. Acute appendicitis: Epidemiology, treatment and outcomes- analysis of 16544 consecutive cases. World J Gastrointest Surg [Internet]. 2016;8:693. Available from:
    1. Andersson RE. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg. 2007;31:86–92. doi: 10.1007/s00268-006-0056-y.
    1. Blomqvist PG, Andersson RE, Granath F, Lambe MP, Ekbom AR. Mortality after appendectomy in Sweden, 1987–1996. Ann Surg. 2001;233:455–60. doi: 10.1097/00000658-200104000-00001.
    1. Andersson REB. Small bowel obstruction after appendicectomy. Br J Surg. 2001;88:1387–1391. doi: 10.1046/j.0007-1323.2001.01869.x.
    1. Leung TTW, Dixon E, Gill M, Mador BD, Moulton KM, Kaplan GG, et al. Bowel obstruction following appendectomy: What is the true incidence? Ann Surg. 2009;250:51–53. doi: 10.1097/SLA.0b013e3181ad64a7.
    1. Allievi N, Harbi A, Ceresoli M, Montori G, Poiasina E, Coccolini F, et al. Acute appendicitis: still a surgical disease? Results from a propensity score-based outcome analysis of conservative versus surgical management from a prospective database. World J Surg. 2017 doi: 10.1007/s00268-017-4094-4.
    1. Salminen P, Tuominen R, Paajanen H, Rautio T, Nordström P, Aarnio M, et al. Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. JAMA - J Am Med Assoc. 2018;320:1259–1265. doi: 10.1001/jama.2018.13201.
    1. Haijanen J, Sippola S, Tuominen R, Grönroos J, Paajanen H, Rautio T, et al. Cost analysis of antibiotic therapy versus appendectomy for treatment of uncomplicated acute appendicitis: 5-year results of the APPAC randomized clinical trial. PLoS ONE. 2019;14:e0220202. doi: 10.1371/journal.pone.0220202.
    1. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 doi: 10.1186/s13017-020-00306-3.
    1. CODA Collaborative. Flum DR, Davidson GH, Monsell SE, Shapiro NI, Odom SR, et al. A randomized trial comparing antibiotics with appendectomy for appendicitis. N Engl J Med. 2020 doi: 10.1056/NEJMoa2014320.
    1. Podda M, Gerardi C, Cillara N, Fearnhead N, Gomes CA, Birindelli A, et al. Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children. Ann Surg. 2019;270:1028–40. doi: 10.1097/SLA.0000000000003225.
    1. Ceresoli M, Pisano M, Allievi N, Poiasina E, Coccolini F, Montori G, et al. Never put equipoise in appendix! Final results of ASAA (antibiotics vs. surgery for uncomplicated acute appendicitis in adults) randomized controlled trial. Updates Surg. 2019;71.
    1. 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(11):2254–8. doi: 10.1111/ans.16336.
    1. McLean RC, Young J, Musbahi A, Lee JX, Hidayat H, Abdalla N, et al. A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: is there a “lockdown”effect? . Int J Surg. 2020;83:259–66. doi: 10.1016/j.ijsu.2020.09.011.
    1. Alimoglu O, Erol CI, Kayali A, Acar M, Colapkulu N, Leblebici M, Ekinci O, et al. Emergency surgery during COVID-19 pandemic; what has changed in practice? . Br J Surg. 2020;107\(12):e581–2.
    1. Cano-Valderrama O, Morales X, Ferrigni CJ, Martín-Antona E, Turrado V, García A, et al. Acute care surgery during the COVID-19 pandemic in Spain: changes in volume, causes and complications. A multicentre retrospective cohort study. Int J Surg. 2020;80:157–61. doi: 10.1016/j.ijsu.2020.07.002.
    1. Rausei S, Ferrara F, Zurleni T, Frattini F, Chiara O, Pietrabissa A, et al. Dramatic decrease of surgical emergencies during COVID-19 outbreak. J Trauma Acute Care Surg. 2020;89(6):1085. doi: 10.1097/TA.0000000000002923.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. doi: 10.1016/0021-9681(87)90171-8.
    1. Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications. Ann Surg [Internet]. 2004;240:205–13. Available from:
    1. Ministero della Salute Italiano - portale coronavirus. Available from:
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg. 2014;12:1495–1499. doi: 10.1016/j.ijsu.2014.07.013.
    1. Anteby R, Zager Y, Barash Y, Nadler R, Cordoba M, Klang E, et al. The impact of the coronavirus disease 2019 outbreak on the attendance of patients with surgical complaints at a Tertiary Hospital Emergency Department. J Laparoendosc Adv Surg Tech. 2020;30(9):1001–1007. doi: 10.1089/lap.2020.0465.
    1. Finkelstein P, Picado O, Muddasani K, Wodnicki H, Mesko T, Unger S, et al. A retrospective analysis of the trends in acute appendicitis during the COVID-19 pandemic. J Laparoendosc Adv Surg Tech. 2020;31(3):243–246. doi: 10.1089/lap.2020.0749.
    1. 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(11):1508–1512. doi: 10.1177/0003134820972098.
    1. 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 doi: 10.1007/s11605-020-04844-8.
    1. Orthopoulos G, Santone E, Izzo F, Tirabassi M, Pérez-Caraballo AM, Corriveau N, et al. Increasing incidence of complicated appendicitis during COVID-19 pandemic. Am J Surg. 2020 doi: 10.1016/j.amjsurg.2020.09.026.
    1. Maneck M, Günster C, Meyer H-J, Heidecke C-D, Rolle U. Influence of COVID-19 confinement measures on appendectomies in Germany - administrative claims data analysis of 9,797 patients. medRxiv. 2020 doi: 10.1007/s00423-020-02041-4.
    1. Kurihara H, Bisagni P, Faccincani R, Zago M. COVID-19 outbreak in Northern Italy: viewpoint of the Milan area surgical community. J Trauma Acute Care Surg. 2020;8(6):719–724. doi: 10.1097/TA.0000000000002695.
    1. Ielpo B, Podda M, Pellino G, Pata F, Caruso R, Gravante G, et al. Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study. Br J Surg. 2020 doi: 10.1002/bjs.11999.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera