ABSTRACT
Introduction: Measures taken to prevent the spread of coronavirus disease 2019 (COVID-19) slow surgical processes, and patients are avoiding presenting at emergency departments during the outbreak because of fears of contracting the contagious disease. To analyze the rate of complicated appendicitis before and during the COVID-19 pandemic. Methods: We systematically reviewed the PubMed and SCOPUS databases for articles published from 2000 to 2021. Including the retrospective review data collected from our hospital of patients aged ≥18 years old who were diagnosed with acute appendicitis. The primary outcome of complicated appendicitis incidence was compared between before and during the COVID-19 pandemic period. We performed a meta-analysis using a random-effects model analysis. Results: A total 3559 patients were included for meta-analysis. The overall rate of complicated appendicitis was significantly higher during the pandemic (relative risk, 1.55; 95% confidence interval [CI], 1.26-1.89). The time from onset of symptoms to hospitalisation was 0.41 h longer during the pandemic, which was not significantly different (standardized mean difference, 0.41, 95% CI, -0.03 to 1.11). The operating time during the pandemic was significantly shorter than that before the pandemic (83.45 min and 71.65 min, p = 0.01). Conclusion: There are correlation between the pandemic and severity of acute appendicitis. The higher rate of complicated appendicitis in the pandemic indicates that patients require timely medical attention and appropriate treatment despite fears of contracting disease.
ABSTRACT
BACKGROUND: Coronavirus disease (COVID-19) has impacted both emergency and elective surgical management owing to its highly infectious nature and the shortage of personal protective equipment. This study aimed to review the outcomes of emergency surgical conditions and trauma during the pandemic lockdown. MATERIAL AND METHODS: We retrospectively reviewed and collected data from patients who attended the Acute Care Surgery Service from 1st April to May 31st, 2020 during Thailand's COVID-19 pandemic lockdown. We separated staff and performed preoperative COVID-19 swab testing on all patients to assess the requirement for personal protective equipment. Compared with previous years of service, of 2018 and 2019. Preoperative COVID-19 testing was performed using multiplex and manual RT-PCR. Morbidity and mortality, consultation time, and waiting time to surgery were analyzed. RESULTS: A total of 61 patients were enrolled. The average age of patients was 53.8 years. The average consultation time, waiting time to surgery, and surgical duration were 10 min, 660 min, and 88.77 min, respectively. The average time taken to obtain the preoperative COVID-19 test result was 227.26 min. The morbidity and mortality rates were 9.84% and 1.64%, respectively. Compared with the same period in 2018 and 2019, consultation time was significantly faster (10 min; p = 0.033) and waiting time to surgery was significantly longer (660 min, respectively; p = 0.011). Morbidity and mortality between pandemic period and the previous year of service were not significantly different. No medical workers were infected with COVID-19. CONCLUSIONS: During the COVID-19 pandemic, optimal triage of emergency patients is key. Waiting for preoperative COVID-19 swab testing in emergency case is safe and results in good outcomes. Although the waiting time to surgery was significantly longer owing to the time required to receive preoperative COVID-19 swab results, morbidity and mortality rates were unaffected.