Management of acute appendicitis during COVID-19 pandemic. Single center data from a tertiary care hospital in Germany.

Abstract

The unexpected global overload of the health system during COVID-19 pandemic has caused changes inmanagement of acute appendicitis worldwide. Whereas conservative treatment was widely recommended, the appendicectomy remained standard therapy in Germany. We aimed to investigate the impact of COVID-19 pandemic ontreatment routine for acute appendicitis at University Hospital of Magdeburg. Adult patients with clinical and/or radiological diagnosis of acute appendicitis were included in the single center retrospective study. Data was collected to patient demographics, treatment modality and outcomes including morbidity and length of stay. The patient data related to COVID-19 period from March 22, 2020 to December 31, 2021 (649days) were compared to the Non-COVID-19 period from June 12, 2018 to March 21, 2020 (649days). Subgroup analysis related to conservative or surgical treatment has been performed. A total of 385 patients was included in the study, 203 (52.73%) during Non-COVID-19 period and 182 (47.27%) during COVID-19 period. Mean age of entire collective was43.28 years, containing 43.9% female patients (p=0.095). Conservative treatment was accomplished in 49 patients (12.7% of entire collective), increasing from 9.9 % to 15.9% during COVID-19 period (p=0.074). Laparoscopic appendicectomy was performed in 99.3% (n=152) of operated patients during COVID-19 period (p=0.013), followed by less postoperative complications compared to reference period (23.5% vs. 13.1%, p=0.015). The initiation of antibiotic therapy after the diagnosis increased from 37.9 % to 53.3% (p=0.002) during COVID-19 period regardless the following treatment modality. Antibiotic treatment showed shorter duration during pandemic period (5.57days vs. 3.16days, p<0.001) and it was given longer in the conservative treatment group (5.63days vs. 4.26days, p=0.02). The overall length of stay was shorter during COVID-19 period (4.67days vs. 4.12 days, p=0.052) and in the conservative treatment group (3.08days vs. 4.47days, p<0.001). However, the overall morbidity was lower during the COVID-19 period than before (17.2% vs. 7.7%, p=0.005) and for conservative therapy compared toappendicectomy (2 % vs. 14.3%, p=0.016). There was no mortality documented. According to our findings the COVID-19 pandemic had a relevant impact on treatment of acute appendicitis, but it was possible to maintain the traditional diagnostic and treatment pathway. Although laparoscopic appendicectomy remains a recommended procedure, the conservative treatment of uncomplicated appendicitis with excellent short-term outcome can be a safe alternative to surgery during potential new wave of COVID-19 pandemic and in the daily routine.