ABSTRACT
Aims The aim of this study was to compare the patient demographics and management of acute manifestations of gallstone disease during the COVID-19 pandemic with an equivalent period in 2019 and assess the differences in recurrence patterns over the period of first and second wave of the pandemic. Methods A retrospective cohort study of all adult patients aged >16 years presenting to the emergency department at a large District General Hospital with symptoms related to gallstones was conducted. Data was obtained from electronic patient records. Primary outcome assessed were incidence and management of gallstone disease while secondary outcome studied included length of Stay, re-admission rate and recurrence. Data was tabulated and analyzed using Excel (Microsoft, 2016 version). Chi square, t-test and One way ANOVA tests were used. Results 51 patients presented during the period of first wave and 105 patients during second wave as compared to 71 patients in the study period during 2019. The median age of patients during the first wave of COVID was significantly higher than pre COVID and that in second wave. During both the waves of the pandemic, there was a no significant difference in patients presenting with cholecystitis compared with 2019 (47 and 94 versus 60;p value 0.39). There was no significant increase in use of cholecystostomy. There was no significant difference in recurrence and readmissions. Majority of the patients still await surgery. Conclusion During the pandemic, older patients with higher comorbidity presented with acute gallstone disease. Conservative management was effective in the management of these patients.
ABSTRACT
BACKGROUND: Appendicitis accounts for the most frequent surgical emergencies in childhood. The guidance from the Royal College of Surgeons and poor post operative outcomes in surgical patients during the pandemic, it would be expected that only children who had clinical signs of appendicitis and were unwell, would have undergone surgery. Hence, the negative appendicectomy rate during the pandemic should have decreased.The aim of this retrospective study was to assess the rate of negative appendicectomy amongst children <16 years of age during the first wave of the pandemic, from the announcement of the lockdown and determine if there was a true difference by comparing the rate with the same time period in 2019. MATERIAL AND METHODS: Data of all children aged<16 years who were operated for appendicitis between 23/3/2020 and 30/06/2020 was collected retrospectively and compared with that of children operated during the same time period in 2019 for the rate of negative appendicectomy.Data were analysed using the two-tailed t-test for continuous data and χ2 or Fishers exact tests for categorical data with p value of <0.05 considered significant. RESULTS: Twenty three paediatric patients presenting with acute appendicitis underwent appendicectomy during the COVID-19 pandemic and 35 patients during 2019.Overall 17.39% patients underwent laparoscopic appendicectomy in 2020 while 54.29% in 2019. The negative appendicectomy rate was zero during the pandemic while it was 17.14% in 2019. There was no difference in the median length of hospital stay during the two time periods. There was no significant difference in complication or re-admission rate. CONCLUSION: This study has the lowest reported incidence of negative appendicectomy rate during the pandemic following wider use of pre operative imaging and early senior involvement in decision making. The increased number of complicated appendicitis during the pandemic did not translate to worse clinical outcomes.