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COVID-19 opens the door for right iliac fossa pain treatment pathway
Annals of the Royal College of Surgeons of England ; 104(4):302-307, 2022.
Article in English | ProQuest Central | ID: covidwho-2251050
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.
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Collection: Databases of international organizations Database: ProQuest Central Language: English Journal: Annals of the Royal College of Surgeons of England Year: 2022 Document Type: Article

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Collection: Databases of international organizations Database: ProQuest Central Language: English Journal: Annals of the Royal College of Surgeons of England Year: 2022 Document Type: Article