ABSTRACT
Aims During the first wave of the COVID-19 pandemic (March-June 2020), surgeons were advised where possible to avoid operating on appendicitis due to the perioperative risk for patients and theatre staff. This resulted in an increase in conservative management and a decreased negative appendicectomy rate (NAR) (COVID:HAREM). We sought to assess if the experience in 2020 had changed practice a year on. Methods Data collection was undertaken of patients presenting acutely with appendicitis or clinical appendicitis requiring diagnostic laparoscopy, using the electronic records. Data was collected over the same three-month period in 2019, 2020 and 2021. Patient's electronic records were reviewed. Results In total 174 patients were identified over the three-year period (59, 46 and 69). Mean age was 42 and 55% were female. The number of patients undergoing US scans dropped during the pandemic (36%, 26% and 41%) whereas CT use increased (37%, 63% and 46%). In 2021, conservative management of patients had not returned to pre-pandemic levels (5%, 46% and 19%). NAR were 12%, 0% and 5%. Mean length of stay was unchanged (3.3, 3.9 and 3.5days). Conclusions This study demonstrates the change of practice during and following the first wave of pandemic. In 2020, more patients were undergoing a diagnostic imaging and fewer patients were undergoing an operation compared to 2019, demonstrated improvement in the NAR in 2020. Although these changes have dampened in 2021, the trend is still present;there is an improved NAR in 2021 compared to 2019, possibly due to more patients undergoing CT.
ABSTRACT
OBJECTIVE: There is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection. DESIGN: A prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups. RESULTS: 1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection. CONCLUSION: Patients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.