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Ann R Coll Surg Engl ; 2022 May 31.
Article in English | MEDLINE | ID: covidwho-1875066


INTRODUCTION: Conservative management with antibiotics was recommended by the UK Surgical Royal Colleges early in the COVID-19 pandemic as the first-line treatment for acute uncomplicated appendicitis. METHODS: This is a prospective single-centre cohort study of patients aged 16 years or over, diagnosed clinically and confirmed radiologically with acute appendicitis in a secondary care setting who were initially treated conservatively with antibiotics. The primary outcome was the response to conservative management with antibiotics. Secondary outcomes were: antibiotic duration; operative rates; surgical approach (open, laparoscopic or conversion to open); complication rates; COVID-19 positive rate; rates of readmission within 12 months; and length of hospital stay. RESULTS: A total of 109 patients were included in the study, 67 of whom were male. Median age was 37 (range 17-93) years. A further 28 patients were excluded because of a decision to manage operatively on the index admission or because of other diagnoses. Thirty-three patients (30.3%) had surgery on the index admission after failed conservative management and 15 (13.8%) had surgery on readmission. On histology, 32/48 patients (66.7%) had a diagnosis of complicated appendicitis and 18/48 (37.5%) had a confirmed appendicolith. CONCLUSIONS: There was a high readmission rate (47/109; 43.1%) for surgery, a radiological drain or conservative management within the first year following initial conservative management. There is a significant risk of recurrence of symptoms, particularly in the presence of an appendicolith. Laparoscopic appendicectomy should be the first-line treatment, with conservative management reserved for patients with acute uncomplicated appendicitis who are COVID-19 positive or have comorbidities.

British Journal of Surgery ; 108:1, 2021.
Article in English | Web of Science | ID: covidwho-1539394
British Journal of Surgery ; 108:216-216, 2021.
Article in English | Web of Science | ID: covidwho-1539381
British Journal of Surgery ; 108(SUPPL 2):ii21, 2021.
Article in English | EMBASE | ID: covidwho-1254452


Background: The United Kingdom now has one of the highest death rates from COVID 19, with over 40,000 deaths (1). It has been posited that the identification of care workers with immunity or increased resistance could be important in developing future strategies. Method: This was a retrospectively conducted survey of general surgical staff at a tertiary surgical unit. Results: We surveyed 215 staff that had undergone antibody testing. Of the 175/215 who reported contact with COVID-19 positive patients, 6/ 215 had a positive PCR result and 15/215 reported a positive antibody test. Only 3/6 that had a positive PCR test demonstrated antibodies. Conclusions: Our immunity rate of 7% is extremely low and is concerning especially in respect of the anticipated herd immunity which would mitigate many of the issues presently being confronted and it is likely to be many months at least before this makes realistic contribution. Continued testing for the presence of COVID-19 antibodies will contribute to crucial seroprevalence data that can be used by public health bodies whose advice will necessarily evolve as increasing data sets become available.