Abstract
Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March–April 2019 vs March–April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020
Highlights
With about 60 million global infections and more than 1.5 million deaths at the end of 2020, the COVID-19 pandemic has radically changed the world [1]
The CRAC study (ChiRurgia Appendiciti COVID-19, COVID-19 Appendicitis Surgery) is a national multicentre, retrospective, observational cohort study to assess the surgical outcomes of patients undergoing an appendectomy
We investigated the model’s performance on the test set and identified the best prediction performance by the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) curve
Summary
With about 60 million global infections and more than 1.5 million deaths at the end of 2020, the COVID-19 pandemic has radically changed the world [1]. Hospitals and healthcare systems had to face a significant number of infected patients needing treatment. We significantly reduced surgical activity in the elective setting of about 30 million surgical procedures worldwide in a period of 12 weeks [2]. Surgeons cannot postpone emergency and oncological procedures. They issued their recommendations [3,4,5] suggesting caution while performing surgery. At the beginning of the pandemic, major surgical societies and colleges advised using non-operative management of appendicitis and recommended against laparoscopy [6, 7]
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