COVID-19 opens door for new Right Iliac Fossa pain Treatment (RIFT) pathway

ABSTRACT

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.