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Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study.
Ielpo, B; Podda, M; Pellino, G; Pata, F; Caruso, R; Gravante, G; Di Saverio, S.
  • Ielpo B; Department of Surgery, Hepatopancreatobiliary Unit, University Hospital Leon, Leon, Spain.
  • Podda M; Department of General and Emergency Surgery, Cagliari University Hospital, Azienda Ospedaliero-Universitaria, Cagliari, Italy.
  • Pellino G; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
  • Pata F; Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.
  • Caruso R; General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.
  • Gravante G; Department of General Surgery, La Sapienza University, Rome, Italy.
  • Di Saverio S; Hospital Universitario HM Sanchinarro, Madrid, Spain.
Br J Surg ; 108(6): 717-726, 2021 06 22.
Article in English | MEDLINE | ID: covidwho-837718
ABSTRACT

BACKGROUND:

Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis.

METHODS:

The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic.

RESULTS:

Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P < 0·001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe.

CONCLUSION:

Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2.
RESUMEN
ANTECEDENTES Las estrategias quirúrgicas están siendo adaptadas en presencia de la pandemia de la COVID-19. Las recomendaciones del tratamiento de la apendicitis aguda se han basado en la opinión de expertos, pero hay muy poca evidencia disponible. Este estudio abordó este aspecto a través de una visión de los enfoques mundiales de la cirugía de la apendicitis.

MÉTODOS:

La Asociación de Cirujanos Italianos en Europa (ACIE) diseñó una encuesta electrónica en línea para evaluar la actitud actual de los cirujanos a nivel mundial con respecto al manejo de pacientes con apendicitis aguda durante la pandemia. Las preguntas se dividieron en información basal, organización del hospital y cribaje, equipo de protección personal, manejo y abordaje quirúrgico, así como las características de presentación del paciente antes y durante de la pandemia. Se utilizó una prueba de ji al cuadrado para las comparaciones.

RESULTADOS:

De 744 respuestas, se habían completado 709 (66 países) cuestionarios, los datos de los cuales se incluyeron en el estudio. La mayoría de los hospitales estaban tratando a pacientes con y sin COVID. Hubo variabilidad en las indicaciones de cribaje de la COVID-19 y en la modalidad utilizada, siendo la tomografía computarizada (CT) torácica y el análisis molecular (PCR) (18,1%) las pruebas utilizadas con más frecuencia. El tratamiento conservador de la apendicitis complicada y no complicada se utilizó en un 6,6% y un 2,4% antes de la pandemia frente a un 23,7% y un 5,3% durante la pandemia (P < 0.0001). Un tercio de los encuestados cambió la cirugía laparoscópica a cirugía abierta debido a las recomendaciones de los grupos de expertos (pero carente de evidencia científica) durante la fase inicial de la pandemia. No hubo acuerdo en cómo filtrar el humo generado por la laparoscopia. Hubo una reducción general del número de pacientes ingresados con apendicitis y un tercio consideró que los pacientes atendidos presentaban una apendicitis más grave que las comúnmente observadas.

CONCLUSIÓN:

La pandemia ha demostrado que ha sido posible el tratamiento conservador de la apendicitis leve. El hecho de que algunos cirujanos cambiaran a una apendicectomía abierta podría ser el reflejo de las pautas deficientes que se propusieron en la fase inicial del SARS-CoV2.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Appendicitis / Practice Patterns, Physicians&apos; / Attitude of Health Personnel / Surgeons / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Br J Surg Year: 2021 Document Type: Article Affiliation country: Bjs.11999

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Appendicitis / Practice Patterns, Physicians&apos; / Attitude of Health Personnel / Surgeons / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Br J Surg Year: 2021 Document Type: Article Affiliation country: Bjs.11999