Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis: a comparison between 2019 and 2020

BMC Emergency Medicine

Lotte C. Franken¹  Wouter J. A. Sedee²  Jan M. Prins³  Jaap Stoker⁴  Carl A. J. Puylaert⁴  Hester A. Gietema⁵  Eduard A. van Bodegraven⁶  David M. Mens⁷  Marja A. Boermeester⁸  Jochem C. G. Scheijmans⁸  Wouter J. Bom⁸  Suzanne S. Gisbertz⁹  Marc G. H. Besselink⁹  Alexander B. J. Borgstein⁹  Nando J. M. M. Reneerkens^1,10  Toon J. L. Kuypers^1,11  Michelle R. de Graaff^1,12  Roy Couvreur^1,13  Floor M. ter Brugge^1,14  Amarins T. A. Brandsma^1,15  Marcia P. Gaspersz^1,16  Ricardo G. Orsini^1,17  Said Bachiri^1,18  Suzanne C. Kleipool^1,19  Steve M. M. de Castro^1,19  José H. Volders^2,20  Shahzad Tavakoli Rad^2,21  Pepijn D. Weeder^2,22  Hannah Groenen^2,23  Thomas Schok^2,24  Milou H. Martens^2,25 

[1] Departement of Surgery, Flevo Hospital, Almere, the Netherlands;Department of Emergency Medicine, St Jansdal Hospital, Harderwijk, the Netherlands;Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, the Netherlands;Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands;Department of Surgery, Amphia Hospital, Breda, the Netherlands;Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands;Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;Department of Surgery, Dijklander Hospital, Hoorn, the Netherlands;Department of Surgery, Elisabeth - Tweesteden Hospital, Tilburg, the Netherlands;Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands;Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands;Department of Surgery, Hospital Group Twente, Almelo, the Netherlands;Department of Surgery, Isala Hospital, Zwolle, the Netherlands;Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands;Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands;Department of Surgery, Noordwest Hospital Group, Alkmaar, the Netherlands;Department of Surgery, OLVG, Amsterdam, the Netherlands;Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands;Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands;Department of Surgery, Spaarne Gasthuis, and Hoofddorp, Haarlem, the Netherlands;Department of Surgery, Tergooi Hospitals, Hilversum, the Netherlands;Department of Surgery, VieCuri Medisch Centrum for Noord-Limburg, Venlo, the Netherlands;Department of Surgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands;

关键词: Acute appendicitis;    COVID-19 pandemic;    Complicated appendicitis;   

DOI  :  10.1186/s12873-021-00454-y

来源: Springer

【 摘 要 】

BackgroundDuring the COVID-19 pandemic, a decrease in the number of patients presenting with acute appendicitis was observed. It is unclear whether this caused a shift towards more complicated cases of acute appendicitis. We compared a cohort of patients diagnosed with acute appendicitis during the 2020 COVID-19 pandemic with a 2019 control cohort.MethodsWe retrospectively included consecutive adult patients in 21 hospitals presenting with acute appendicitis in a COVID-19 pandemic cohort (March 15 – April 30, 2020) and a control cohort (March 15 – April 30, 2019). Primary outcome was the proportion of complicated appendicitis. Secondary outcomes included prehospital delay, appendicitis severity, and postoperative complication rates.ResultsThe COVID-19 pandemic cohort comprised 607 patients vs. 642 patients in the control cohort. During the COVID-19 pandemic, a higher proportion of complicated appendicitis was seen (46.9% vs. 38.5%; p = 0.003). More patients had symptoms exceeding 24 h (61.1% vs. 56.2%, respectively, p = 0.048). After correction for prehospital delay, presentation during the first wave of the COVID-19 pandemic was still associated with a higher rate of complicated appendicitis. Patients presenting > 24 h after onset of symptoms during the COVID-19 pandemic were older (median 45 vs. 37 years; p = 0.001) and had more postoperative complications (15.3% vs. 6.7%; p = 0.002).ConclusionsAlthough the incidence of acute appendicitis was slightly lower during the first wave of the 2020 COVID-19 pandemic, more patients presented with a delay and with complicated appendicitis than in a corresponding period in 2019. Spontaneous resolution of mild appendicitis may have contributed to the increased proportion of patients with complicated appendicitis. Late presenting patients were older and experienced more postoperative complications compared to the control cohort.

【 授权许可】

CC BY