Management of Acute Appendicitis During the COVID-19 Pandemic is Significantly Different: A Retrospective Single UK Hospital Study

Abstract

Mohammad Noah Hasan Khan,1 Abdul Basit Jamal,2 Ahmad Faraz,3 Hassan Shafique,4 Muhammad Umar Rasool,5 Muhammad Waqas Ilyas,6 Muhammd Hamza Jamshed,7 Waleed Riaz,8 Mehwish Usman9 1Trauma and Orthopedic Surgery, Royal Victoria Hospital, Belfast, Northern Ireland; 2Trauma and Orthopedic Surgery, Ittefaq Hospital Trust, Lahore, Pakistan; 3Department of General Surgery, Royal Victoria Hospital, Belfast, Northern Ireland; 4Trauma and Orthopedic Surgery, Royal London Hospital, London, UK; 5Trauma and Orthopedic Surgery, North Manchester General Hospital, Manchester, UK; 6Trauma and Orthopaedics University Hospital Southampton, Southampton Hampshire, UK; 7Trauma and Orthopedics, The Hillingdon Hospitals NHS Trust, Uxbridge, UK; 8General Surgery Royal Victoria Hospital, Belfast, Northern Ireland; 9Trauma and Orthopedics, Manchester Royal Infirmary, Manchester, UKCorrespondence: Mohammad Noah Hasan KhanTrauma and Orthopedic Surgery, Royal Victoria Hospital, Belfast, Northern IrelandEmail [email protected]: The COVID-19 pandemic has led to a change in the delivery of acute and emergency surgical services. With emphasis on reducing unnecessary operative intervention and performing more CT scans, there has been a shift in managing acute appendicitis conservatively. We evaluate the impact of this shift on the management of acute appendicitis.Methods: A single UK centre retrospective study evaluating patients with suspected acute appendicitis pre-COVID-19 rota (18 March 2020) and post-COVID rota implementation. Data including demographics, inflammatory markers, imaging, mode of management and operative findings were collected. Logistic regression with SPSS was used to determine which factors were associated with conservative management and treated with antibiotics.Results: A total of 161 patients were analysed, 82 pre-COVID19 and 79 post-COVID19. Of the pre-COVID-19 patients, 67.07% underwent appendicectomy while the rest were conservatively managed; 24.3% of these patients underwent a CT scan only. Post-COVID-19, 22.78% of patients underwent appendicectomy with a higher percentage of diagnostic CT scans performed, 43/79 (54.4%, p < 0.001). The proportion of histologically normal appendicectomies was significantly reduced in the post-COVID-19 era (12.78% vs 0.00%; p-value 0.001). Logistic regression analysis showed a normal WCC to be associated with greater likelihood of conservative management. No conservatively managed patients returned to theatre in the 30-day follow-up period.Conclusion: Due to the restrictions imposed by the post-COVID-19 rota, a greater proportion of patients were managed conservatively with comparable patient outcomes. The approach also led to fewer negative appendicectomies owing to greater reliance on imaging.Keywords: appendicitis, COVID-19, imaging, non-operative management

Keywords

• appendicitis
• covid-19
• imaging
• non-operative management