Management of Acute Appendicitis during Covid Pandemic-What Did We Learn

ABSTRACT

Aim: During the COVID-19 pandemic, UK intercollegiate guidelines shifted to favour non-operative approach and open surgical approach when required in the management of acute appendicitis. The aim of this study was to assess diagnostic and management approaches during the COVID-19 peak and post-peak period and further evaluate short term patient outcomes. Method(s) A retrospective observational study was performed which included all patients with a clinical or radiological diagnosis of acute appendicitis during peak of COVID-19 (01/04/2020-30/ 06/2020) and post-peak (01/07/2020-30/ 09/2020). Patient demographics, clinical presentation, investigative findings, management approach and clinical outcomes were recorded by two observers. Result(s) Sample consisted of 188 patents (COVID peak N = 88;post-peak N = 102). There was no significant difference between baseline characteristics (age, ASA, FM, biochemical markers, CT findings). The median duration of symptoms were 1.5 days during peak and 2 days post-peak. During COVID peak more imaging was performed to confirm the diagnosis (peak 69.3% vs post peak 57%;P = 0.081) with CT being the most common modality (N = 101, 76.5%). Majority of the patients were managed surgically during both periods (79.5% vs 81%). Conservative management failure rate was 27% (N = 10) (peak 27.8% vs post-peak 26.3%). More laparoscopic appendicectomies were performed during post-peak period (96.5% vs 65.3%;P < 0.001) and open appendicectomies were more frequent during peak (34.7% vs 3.4%;P < 0.001). There were no significant differences identified in patient outcomes between the two groups (P > 0.05). Only one patient developed mild COVID postoperatively. Less negative appendicectomies were performed during COVID peak (10.7% vs 16.5% post-peak). Conclusion(s) Laparoscopic appendicectomy remains to be a safe approach to manage acute appendicitis, even in 'time-limited' situations. Cross sectional imaging is a helpful tool in aiding the appropriate management plan in acute appendicitis cases.