Management of appendicitis in coronavirus disease 2019, severe acute respiratory syndrome coronavirus 2, pandemic era: decreasing incidence with increasing complicated cases?

OBJECTIVE: This study aimed to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on appendicitis and the relevant outcomes in a tertiary hospital, designated as a "pandemic institution" by the Ministry of Health, between pre-COVID-19 and post-COVID-19, i.e., between 2019 and 2020, of the identical period in terms of the annual schedule. METHODS: The data of cases with acute appendicitis, who were followed up at the Department of General Surgery, a 400-bed, tertiary care, a university-affiliated education and research hospital, providing health care to a population of approximately 450,000 people, during the novel coronavirus SARS-CoV-2, during the identical time intervals of pre-COVID-19 (March 12, 2020 to November 12, 2020) and post-COVID-19 (March 12, 2019 to November 12, 2019), were retrospectively analyzed in a detail. RESULTS: Of the 212 appendectomy operations in total, 99 (46.7%) were performed in the pre-COVID-19 and 113 (53.3%) were performed in post-COVID-19. Compared to the pre-pandemic period, patients who had undergone appendectomies in post-COVID-19 revealed significantly lower neutrophil counts and significantly greater appendix diameters (p<0.001 for both). A significantly lower (p=0.041) acute appendicitis with abundant gangrenous appendicitis and phlegmonous appendicitis (p=0.043 and p=0.032, respectively) was recognized in post-COVID-19 compared with pre-COVID-19 interval. CONCLUSION: The number of appendectomy operations decreased in the COVID-19 pandemic. Patients operated during the pandemic period had wider appendix diameter and lower neutrophil levels. The pathological diagnosis was less frequent acute appendicitis, more frequent gangrenous appendicitis, and phlegmonous appendicitis in the pandemic period.

Analysis of patients with emergency surgery in a pandemic hospital.

AIM: This study aimed at comparing the patients that received emergency management surgery (surgery and medical treatment) in our hospital, which is a pandemic hospital and provides emergency surgery, with the pre-pandemic period. MATERIAL AND METHODS: Data of the patients who received treatment at the emergency surgery clinic of our hospital between March 12 and May 12, 2020, were compared with those of the patients treated between March 12 and May 12, 2019. RESULTS: A 55% decrease was observed in the number of patients hospitalized in the emergency surgery clinic. There was a 37% decrease in the number of patients with medical treatment, a 63% decrease in the number of the operated patients, and a 60% decrease in the number of patients hospitalized due to trauma. CONCLUSION: Patients requiring urgent surgical treatment hesitate to apply to the pandemic hospital. Histopathologically, delayed surgery might be concerned with significantly more-inflammatory alterations which may lead to irreversible histopathologic and cytostructural changes in the era of emergency surgery. Therefore, we assume that it would be more useful to follow up and treat COVID-19 suspected and positive patients in the pandemic hospitals and to provide the emergency branch service in other hospitals in case of a possible second wave. KEY WORDS: COVID-19, SARS-CoV-2, Pandemic, Trauma, Emergency surgery, Emergency.