Delayed diagnosis and subsequently increased severity of acute appendicitis (compatible with clinical-pathologic grounds) during the COVID-19 pandemic: an observational case-control study

Amitai Bickel,Rola Francis,Inbal Farkash,Isaac Cohen,Nour Karra,Samer Ganam,Ibrahim Abu Shakra,Fahed Merei,Eli Kakiashvili

doi:10.1186/s12876-021-02024-9

Abstract

BackgroundDuring a global crisis like the current COVID-19 pandemic, delayed admission to hospital in cases of emergent medical illness may lead to serious adverse consequences. We aimed to determine whether such delayed admission affected the severity of an inflammatory process regarding acute appendicitis, and its convalescence.MethodsIn a retrospective observational cohort case-control study, we analyzed the medical data of 60 patients who were emergently and consecutively admitted to our hospital due to acute appendicitis as established by clinical presentation and imaging modalities, during the period of the COVID-19 pandemic (our study group). We matched a statistically control group consisting of 97 patients who were admitted during a previous 12-month period for the same etiology. All underwent laparoscopic appendectomy. The main study parameters included intraoperative findings (validated by histopathology), duration of abdominal pain prior to admission, hospital stay and postoperative convalescence (reflecting the consequences of delay in diagnosis and surgery).ResultsThe mean duration of abdominal pain until surgery was significantly longer in the study group. The rate of advanced appendicitis (suppurative and gangrenous appendicitis as well as peri-appendicular abscess) was greater in the study than in the control group (38.3 vs. 21.6%, 23.3 vs. 16.5%, and 5 vs. 1% respectively), as well as mean hospital stay.ConclusionsA global crisis like the current viral pandemic may significantly affect emergent admissions to hospital (as in case of acute appendicitis), leading to delayed surgical interventions and its consequences.

Highlights

Acute appendicitis is considered one of the most common abdominal emergencies.Theetiology is diverse and not always clear, and include mucosal ulceration due toenteric infection, foreign bodies, ischemia, and luminal obstruction
During 6-months along the main surges of COVID19 pandemic period, 60 patients were presented to our department of surgery suffering acute appendicitis
During the 12-months of the control period, 97 patients suffering from acute appendicitis were admitted (Table 1)

Summary

Introduction

Acute appendicitis is considered one of the most common abdominal emergencies.Theetiology is diverse and not always clear, and include mucosal ulceration due toenteric infection, foreign bodies, ischemia, and luminal obstruction. Acute appendicitis is considered one of the most common abdominal emergencies. According to large series, theexpected distribution of the inflammatory process includes severe inflammatorychanges in about 32%, and gangrenous appendicitis in particular in about 13.5% [1, 7, 9,10,11]. These distributions may vary considerably according to age, gender, andcomorbidities. We aimed to determine whether such delayed admission affected the severity of an inflammatory process regarding acute appendicitis, and its convalescence

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