ABSTRACT
IntroductionThe COVID-19 pandemic has increased the risks of surgery and management of common surgical conditions has changed, with greater reliance on imaging and conservative management. The negative appendectomy rate (NAR) in the UK has previously remained high. The aim of this study was to quantify pandemic-related changes in the management of patients with suspected appendicitis, including the NAR.MethodsA retrospective study was performed at a single high volume centre of consecutive patients aged over five years presenting to general surgery with right iliac fossa pain in two study periods: for two months before lockdown and for four months after lockdown. Pregnant patients and those with previous appendectomy, including right colonic resection, were excluded. Demographic, clinical, imaging and histological data were captured, and risk scores were calculated, stratifying patients into higher and lower risk groups. Data were analysed by age, sex and risk subgroups.ResultsThe mean number of daily referrals with right iliac fossa pain or suspected appendicitis reduced significantly between the study periods, from 2.92 before lockdown to 2.07 after lockdown (p<0.001). Preoperative computed tomography (CT) rates increased significantly from 22.9% to 37.2% (p=0.002). The NAR did not change significantly between study periods (25.5% prior to lockdown, 11.1% following lockdown, p=0.159). Twelve (75%) out of sixteen negative appendectomies were observed in higher risk patients aged 16–45 years who did not undergo preoperative CT. The NAR in patients undergoing CT was 0%.ConclusionsGreater use of preoperative CT should be considered in risk stratified patients in order to reduce the NAR.
ABSTRACT
INTRODUCTION: The COVID-19 pandemic has increased the risks of surgery and management of common surgical conditions has changed, with greater reliance on imaging and conservative management. The negative appendectomy rate (NAR) in the UK has previously remained high. The aim of this study was to quantify pandemic-related changes in the management of patients with suspected appendicitis, including the NAR. METHODS: A retrospective study was performed at a single high volume centre of consecutive patients aged over five years presenting to general surgery with right iliac fossa pain in two study periods: for two months before lockdown and for four months after lockdown. Pregnant patients and those with previous appendectomy, including right colonic resection, were excluded. Demographic, clinical, imaging and histological data were captured, and risk scores were calculated, stratifying patients into higher and lower risk groups. Data were analysed by age, sex and risk subgroups. RESULTS: The mean number of daily referrals with right iliac fossa pain or suspected appendicitis reduced significantly between the study periods, from 2.92 before lockdown to 2.07 after lockdown (p<0.001). Preoperative computed tomography (CT) rates increased significantly from 22.9% to 37.2% (p=0.002). The NAR did not change significantly between study periods (25.5% prior to lockdown, 11.1% following lockdown, p=0.159). Twelve (75%) out of sixteen negative appendectomies were observed in higher risk patients aged 16-45 years who did not undergo preoperative CT. The NAR in patients undergoing CT was 0%. CONCLUSIONS: Greater use of preoperative CT should be considered in risk stratified patients in order to reduce the NAR.
Subject(s)
Appendicitis , COVID-19 , Acute Disease , Adolescent , Adult , Appendectomy , Appendicitis/complications , Appendicitis/diagnosis , Appendicitis/epidemiology , COVID-19/epidemiology , Child, Preschool , Communicable Disease Control , Humans , Ilium , Middle Aged , Pain , Pandemics , Retrospective Studies , Young AdultABSTRACT
Aims: The COVID-19 pandemic has increased pressure on surgical services, increased the risks of surgery, and forced changes in surgical practice. The UK has a high negative appendicectomy rate (NAR) compared to other countries. We aimed to quantify change in the use of pre-operative imaging due to the pandemic in patients with suspected appendicitis and whether this has reduced the NAR. Methods: We performed a retrospective single-centre cohort study including consecutive patients aged 16-45 referred with right iliac fossa pain or suspected appendicitis in 2 periods: from Jan 26th to Mar 25th, and from Mar 26th until Jul 25th, 2020. Patients who had previously had an appendicectomy or were pregnant were excluded. Patients were analysed according to age, sex and risk score. Results: 85 male and 165 female patients were included across both study periods. 94 (37.6%) patients were identified as low-risk, of whom 0 (0%) underwent appendicectomy. The use of CT imaging was significantly greater in high-risk patients post-lockdown, increasing from 24.2% to 56.1% (P = 0.008817) in males and 18.2% to 41.7% in females (P = 0.03108). In high-risk patients across both periods the NAR was 0% in those undergoing pre-operative CT and 33.3% in those not imaged (P = 0.003995). The NAR did not differ between study periods. The number needed to CT to prevent 1 negative appendicectomy was 9. Conclusion: The use of pre-operative CT imaging is associated with a reduction in NAR to 0%. Risk stratification, and pre-operative CT in high-risk adults, should be considered to reduce the NAR.