Patients with appendicitis during COVID-19 pandemic: a retrospective cohort study.

The Coronavirus Disease 19 (COVID-19) pandemic greatly affected the Quebec healthcare system from spring 2020 onward; the consultation delays that were generated may have delayed the management of urgent intra-abdominal pathologies. Our objective was to evaluate the impact of the pandemic on the length of stay and complications within 30 days of treatment of patients consulting for acute appendicitis (AA) at the Centres intégrés universitaires de santé et de services sociaux (CIUSSS) de l'Estrie-Centre hospitalier universitaire de Sherbrooke (Estrie-CHUS), Quebec, Canada. Methods: The authors conducted a single-center retrospective cohort study on the charts of all patients diagnosed with AA at the CIUSSS de l'Estrie-CHUS between March 13 and June 22, 2019 (control group) and between March 13 and June 22, 2020 (pandemic group). This corresponds to the first wave of COVID-19 in Quebec. Patients included were those with a radiologically confirmed diagnosis of AA. There was no exclusion criteria. Outcomes assessed were length of hospital stay and 30-day complications. Results: The authors analyzed the charts of 209 patients with AA (117 patients in the control group and 92 patients in the pandemic group). No statistically significant difference was observed for the length of stay or the complications between the groups. The only significant difference was the presence of hemodynamic instability on admission (22.2 vs. 41.3%, P=0.004) as well as a trend that did not reach statistical significance regarding the proportions of reoperation before 30 days (0.9 vs. 5.4%, P=0.060). Conclusion: In conclusion, the pandemic did not affect the length of stay of AA managed at the CIUSSS de l'Estrie-CHUS. It is not possible to conclude whether the first wave of the pandemic influenced complications related to AA.

The Suitability of Potential Organ Donors Using Real Case-Scenarios; Do we Need to Create a "Donor Board" Process for Donors Perceived as Unlikely Suitable?

Introduction: Despite availability of selection criteria, different interpretations can lead to variability in the appreciation of donor eligibility with possible viable organs missed. Our primary objective was to test the perception of feasibility of potential organ donors through the survey of a small sample of external evaluators. Methods: Clinical scenarios summarizing 66 potential donors managed in the first year of our Organ Recovery Center were sent to four critical care physicians to evaluate the feasibility of the potential donors and the probability of organ procurement. Results: Potential donors procuring at least one organ were identified in 55 of the 66 cases (83%). Unanimity was reached in 38 cases, encompassing 35 out of the 55 converted and 3 of the non-converted donors. The overall agreement was moderate (kappa = 0.60, 95% CI: 0.37-0.82). For the organs finally procured for transplantation, organ donation was predicted for the majority of the cases, but high discrepancy was present with the final outcome of organs not procured (particularly liver and kidney). Conclusion: The assessment of a potential donor is a complex dynamic process. In order to increase organ availability, standardized electronically clinical data, as well a "donor board" structure of decision might inform future systems.