ABSTRACT
INTRODUCTION: The impact of the SARS-CoV-2 pandemic on healthcare has already been described, since it has caused an increase in diagnostic delay and morbidity. Our objective was to assess its influence on the development of complications in children with acute appendicitis. MATERIALS AND METHODS: A retrospective cohort study was carried out. It included acute appendicitis patients under 15 years of age treated from January 1, 2019 to December 31, 2020. They were classified according to diagnosis date as before the pandemic (B) (January 2019-February 2020) and during the pandemic (D) (March 2020-December 2020). According to operative findings, they were classified as complicated appendicitis (perforated/abscess/plastron/peritonitis) and non-complicated appendicitis (catarrhal/phlegmonous/gangrenous). Demographic data, progression time, and postoperative complications were analyzed. RESULTS: A total of 309 patients were included, 193 (62.5%) in Group B, and 116 (37.5%) in Group D, with an age of 9.2 ± 0.4 and 9.4 ± 0.6 years, respectively (CI = 95%). Diagnostic time was 1.35 and 1.43 days (p>0.05) in Groups B and D, respectively, with ≥ 3 days representing 15.5% of cases in Group B, and 16.4% of cases in Group D (p = 0.84). The proportion of complicated appendicitis was 23.3% in Group B vs. 21.6% in Group D (p>0.05). Postoperative complications were observed in 11.4% of patients in Group B, and in 13.8% of patients in Group D (p>0.05), with intra-abdominal abscess being the most frequent complication in both groups (54.5% of the total complications in Group B vs. 65.5% in Group D; p>0.05). CONCLUSIONS: The management of acute appendicitis and its complications in pediatric patients has not been impacted by the SARS-CoV-2 pandemic or the safety measures enforced.
INTRODUCCION: Se ha descrito el impacto de la pandemia del SARS-CoV-2 en la atención sanitaria, al suponer un aumento del retraso diagnóstico y morbilidad. Nuestro objetivo es evaluar su influencia en el desarrollo de complicaciones en las apendicitis agudas en niños. METODOLOGIA: Estudio retrospectivo de cohortes, incluyendo los pacientes menores de 15 años tratados por apendicitis aguda desde 01/01/2019 hasta 31/12/2020. Se distribuyeron según su fecha de diagnóstico en: antes de la pandemia (A) (enero/2019-febrero/2020) y durante la pandemia (P) (marzo-diciembre/2020). Según los hallazgos quirúrgicos se clasificaron en: apendicitis complicadas (perforadas/abscesos/plastrones/peritonitis) y no complicadas (catarrales/flemonosas/gangrenosas). Se analizaron datos demográficos, tiempo de evolución y complicaciones postoperatorias. RESULTADOS: Se incluyeron un total de 309 pacientes, 193 pacientes (62,5%) en el grupo A y 116 (37,5%) en el P, con edades de 9,2 ± 0,4 y 9,4 ± 0,6 años respectivamente (IC = 95%). Los días al diagnóstico fueron 1,35 y 1,43 (p>0,05) en A y P respectivamente, siendo ≥ 3 días en 15,5% de A y 16,4% en P (p = 0,84). La proporción de apendicitis complicada fue un 23,3% en A vs. 21,6% en P; con p>0,05. Se observaron complicaciones postoperatorias en 11,4% de A y 13,8% de P (p>0,05), siendo la más frecuente el absceso intraabdominal en ambos grupos (54,5% del total de complicaciones vs 65,5%; en A y P respectivamente; p>0,05). CONCLUSIONES: La atención sanitaria de la apendicitis aguda y sus complicaciones en pacientes pediátricos no se ha visto modificada por la pandemia del SARS-CoV-2 o las medidas de seguridad adoptadas durante la misma.
Subject(s)
Appendicitis , COVID-19 , Laparoscopy , Acute Disease , Appendectomy , Appendicitis/complications , Appendicitis/epidemiology , Appendicitis/surgery , COVID-19/complications , Child , Delayed Diagnosis , Humans , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective Studies , SARS-CoV-2ABSTRACT
INTRODUCTION: The SARS-CoV-2 pandemic brought about a reduction in surgical activity. The objective of this work was to analyze its impact on inguinal hernia morbidity. MATERIAL AND METHODS: A retrospective study of cases and controls was carried out. Patients under 18 months of age undergoing inguinal hernia surgery from January 1, 2019 to August 31, 2020 were included. They were divided into two groups: patients undergoing surgery before (group A) or after (group D) the state of alarm was declared in Spain. Primary variables: episodes of incarceration and postoperative complications. Secondary variable: urgent or scheduled surgery. Demographic variables: sex, gestational age (GA), previous pathologies, age at diagnosis (AD), and age at surgery (AS) (months). RESULTS: 64 patients were included - 43 in group A and 21 in group D. In group A, median GA was 37+3, 90.5% of patients were male, median AD was 2.33, and median AS was 3.27. In group D, median GA was 31+2, 72.1% of patients were male, median AD was 3, and median AS was 3.63. There were no statistically significant differences. However, differences in terms of previous pathologies were significant (16.3% for Group A vs. 38.1% for group D) (p = 0.05). Regarding the primary variable, 25.6% of patients in group A had incarcerations vs. 33.3% of patients in group D (p = 0.51), whereas 9.3% of patients in group A had postoperative morbidity vs. 14.3% of patients in group D (p = 0.41). Regarding the secondary variable, 88.4% of surgeries in group A were scheduled vs. 90.5% of surgeries in group D (p = 0.583). CONCLUSION: In spite of reduced surgical activity, inguinal hernia morbidity did not surge in our environment. An increase in patients with previous pathologies was noted, which means severe patients should be prioritized.
INTRODUCCION: La pandemia del SARS-CoV-2 supuso una reducción de las jornadas quirúrgicas. Analizamos el efecto en la morbilidad de la hernia inguinal. MATERIAL Y METODOS: Estudio retrospectivo de casos y controles. Incluimos menores de 18 meses intervenidos de hernia inguinal desde 01/01/2019 hasta 31/08/2020, divididos en 2 grupos: intervenidos antes (grupo A) o después (grupo D) de la declaración del estado de alarma. Variables principales: episodios de incarceraciones y complicaciones postoperatorias. Variable secundaria: intervención urgente o programada. Variables poblacionales: sexo, edad gestacional (EG), patología previa, edad al diagnóstico(ED) y a la intervención (EI) (meses). RESULTADOS: Incluimos 64 pacientes, 43 grupo A y 21 grupo D. En el grupo A la mediana de EG fue 37+3, el 90,5% fueron varones, la mediana ED fue 2,33 y EI 3,27. En el grupo B la mediana de EG fue 31+2, el 72,1% fueron varones, la mediana ED fue 3 y EI 3,63. No hubo diferencias estadísticamente significativas. Si fueron significativas las diferencias en patología previa 16,3% A y 38,1% D (p = 0,05). Sobre la variable principal: 25,6% del A sufrieron incarceraciones frente a 33,3% del D (p = 0,51) y un 9,3% tuvieron morbilidad postoperatoria en A frente a 14,3% en D (p = 0,41). Respecto a la variable secundaria un 88,4% se realizaron de forma programada en el grupo A y un 90,5% en el grupo D (p = 0,583). CONCLUSION: Pese a la reducción de jornadas quirúrgicas no ha aumentado la morbilidad de la hernia inguinal en nuestro medio. Hemos observado un aumento de pacientes con patología previa, implicando la priorización de los pacientes más graves.