BMJ Paediatrics Open (Apr 2020)

Management and early outcomes of children with appendicitis in the UK and Ireland during the COVID-19 pandemic: a survey of surgeons and observational study

  • Nigel J Hall,
  • Vivek Gupta,
  • Anna-may Long,
  • Nuha Yassin,
  • Alan Askari,
  • David Colvin,
  • Stewart Cleeve,
  • Arun Kelay,
  • Chris Driver,
  • Clare Rees,
  • Eleri Cusick,
  • Hetal Patel,
  • Ingo Jester,
  • Khalid Elmalik,
  • Sean Marven,
  • Tim Bradnock,
  • Oliver Brown,
  • Andrew Jackson,
  • Richard Egan,
  • Laura Phillips,
  • Marianne Hollyman,
  • Bankole Oyewole,
  • Fenella Welsh,
  • Dale Vimalachandran,
  • Melissa Gabriel,
  • Kate Cross,
  • Iain Yardley,
  • Mark Peter,
  • Andrew Beamish,
  • Sophie Lewis,
  • Milan Gopal,
  • Joshua McIntyre,
  • Merrill McHoney,
  • Ionica Stoica,
  • Hany Gabra,
  • Tristan Boam,
  • Angeliki Kosti,
  • Katie cross,
  • Andrew Mitchell,
  • Michael Terry,
  • George S Bethell,
  • Clare M Rees,
  • Jonathan R Sutcliffe,
  • Florin Djendov,
  • Victor Emordi,
  • Sarah Staight,
  • Christina Major,
  • Oscar Croysdale,
  • Mike Nelson,
  • Hannah Rhodes,
  • Juliette King,
  • Gillian Winter,
  • Selena Curkovic,
  • Raef Jackson,
  • Bhushanrao Jadhav,
  • Thomas Raymond,
  • Vijay Gangalam,
  • Deepak Selvakumar,
  • Reda Habak,
  • Muslim Abdullah,
  • Mohamed Ahmed Osama,
  • Khlud Asanai,
  • Noman Zafar,
  • Sophia Lewis,
  • Florence Kashora,
  • Dixa Thakrar,
  • Dean Rex,
  • Annita Budzanowski,
  • Jennifer Binnington,
  • Simon Timbrell,
  • Megan Ridgeway,
  • Shirley Chan,
  • Amani Asour,
  • Adetayo Aderombi,
  • Donald Menzies,
  • Ali Murtada,
  • Corina Dragu,
  • Vincent Quan,
  • Krashna Patel,
  • Sesi Hotonu,
  • Ashley Meikle,
  • Ajay Belgaumkar,
  • Prabhat Narayan,
  • Thomas Badenoch,
  • Frances Goulder,
  • Katie Siggens,
  • Kizzie Peters,
  • Fiona Kirkham,
  • Paul Froggatt,
  • Karen Lai,
  • Cristina Navarro,
  • Dorinda Chandrabose,
  • Simon Toh,
  • Elizabeth Gemmill,
  • Keira Lily,
  • Mark Dilworth,
  • Dimitrios Stamatiou,
  • Alasdair Macmillan,
  • Danielle Clyde,
  • Majid Rashid,
  • Gandrapu Srinivas,
  • Katherine Buckley,
  • Darren Smith,
  • Henry Dowson,
  • Gautam Singh,
  • Seshu Kumar Bylapudi,
  • Louise Phillips,
  • Kimberley Hallam,
  • Marisa Clemente,
  • Karol Pal,
  • George Ninkovic-Hall,
  • Emila Paul,
  • Theo Pelly,
  • Joe Vance-Daniel,
  • Venkatesh Kanakala,
  • Edward J Nevins,
  • James Dixon,
  • Michael John,
  • Jude Prince,
  • Georgios Karagiannidis,
  • Suzette Samlalsingh,
  • Chrsitine Ozone,
  • Amina Bouhelal,
  • Siddhartha Handa,
  • Sathasivam Rajeev,
  • Ellen Ross,
  • Ali Wadah,
  • John Hallett,
  • Shirish Tewari,
  • Vinay Shah,
  • Nick Reay-Jones,
  • Salman Bodla,
  • Harriet Corbett,
  • Sumita Chhabra,
  • Athanasios Tyraskis,
  • Benjamin Allin,
  • Angus Fitchie,
  • Michael Stanton,
  • Mark Vipond,
  • Harry Dean,
  • Matthew Boal,
  • Jonathan Goring,
  • Mahmoud Marei,
  • Christian Verhoef,
  • Jonathan Ducey,
  • Chipo Mushonga,
  • Dan Frith,
  • Ashok Ram,
  • Ferzine Mohamed,
  • Nadine Dyar,
  • Rick MacMahon,
  • Mohammed Fakhrul-Aldeen,
  • Iain Bain,
  • Graham Branagan,
  • Rachel Carten,
  • Chee Wan Lai,
  • Anindya Niyogi,
  • Claudia Koh,
  • Christian Fox,
  • Stavros Loukogeorgakis,
  • Joe Curry,
  • Jayaram Sivaraj,
  • Milda Jancauskaite,
  • Helen Please,
  • Wayne Fradley,
  • Maki Jitsumara,
  • Sinead Hassett,
  • Ancuta Muntean,
  • Sarah Yassin,
  • Suzanne Lawther,
  • Ciaran Durand,
  • Mohamed Eltom,
  • Kirsty Brennan,
  • Clara Chong,
  • Hasan Mukhtar,
  • Hany Khalil,
  • Stephanie Clark,
  • Ashish Desai,
  • Amulya Saxena,
  • Joshua Cave,
  • Alistair Sharples,
  • Lukas O’Brien,
  • George Kerans,
  • Ashwini Ghorpade,
  • Felicity Arthur,
  • Muhammad Tobbal,
  • Rachael Robertson,
  • Ben Martin,
  • Ben Woodward,
  • Kieran McGovern,
  • Duncan Rutherford

DOI
https://doi.org/10.1136/bmjpo-2020-000831
Journal volume & issue
Vol. 4, no. 1

Abstract

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Objectives Acute appendicitis is the most common surgical condition in children. In the UK, appendicectomy is the most common treatment with non-operative management unusual. Due to concerns about the risk of SARS-CoV-2 transmission during surgical procedures, surgeons were advised to consider non-operative treatment and avoid laparoscopy where possible. This study aims to report management and outcomes, to date, of children with appendicitis in the UK and Ireland during the COVID-19 pandemic.Design Survey of consultant surgeons who treat children with appendicitis that informed a prospective multicentre observational cohort study.Setting Data were collected from centres in the UK and Ireland for cases admitted between 1 April and 31 May 2020 (first 2 months of the COVID-19 pandemic) at both general surgical and specialist paediatric surgical centres.Participants The study cohort includes 838 children with a clinical and/or radiological diagnosis of acute appendicitis of which 527 (63%) were male.Main outcomes measured Primary outcome was treatment strategy used for acute appendicitis. Other outcomes reported include change in treatment strategy over time, use of diagnostic imaging and important patient outcomes to 30 days following hospital admission.Results From very early in the pandemic surgeons experienced a change in their management of children with appendicitis and almost all surgeons who responded to the survey anticipated further changes during the pandemic. Overall, 326/838 (39%) were initially treated non-operatively of whom 81/326 (25%) proceeded to appendicectomy within the initial hospital admission. Of cases treated initially surgically 243/512 (48%) were performed laparoscopically. Diagnostic imaging was used in 445/838 (53%) children. Cases treated non-operatively had a shorter hospital stay than those treated surgically but hospital readmissions within 30 days were similar between groups. In cases treated surgically the negative appendicectomy rate was 4.5%. There was a trend towards increased use of surgical treatment and from open to laparoscopic appendicectomy as the pandemic progressed.Conclusion Non-operative treatment of appendicitis has been widely used for the first time in children in the UK and Ireland and is safe and effective in selected patients. Overall patient outcomes do not appear to have been adversely impacted by change in management during the pandemic thus far.