Abstract
BackgroundAcute appendicitis (AA) is the most common general surgical emergency. Early laparoscopic appendicectomy is the gold-standard management. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures: as a consequence, conservative management was advised, and open appendicectomy recommended when surgery was unavoidable. This study describes the impact of the first weeks of the pandemic on the management of AA in the United Kingdom (UK).MethodsPatients 18 years or older, diagnosed clinically and/or radiologically with AA were eligible for inclusion in this prospective, multicentre cohort study. Data was collected from 23rd March 2020 (beginning of the UK Government lockdown) to 1st May 2020 and included: patient demographics, COVID status; initial management (operative and conservative); length of stay; and 30-day complications. Analysis was performed on the first 500 cases with 30-day follow-up.ResultsThe patient cohort consisted of 500 patients from 48 sites. The median age of this cohort was 35 [26–49.75] years and 233 (47%) of patients were female. Two hundred and seventy-one (54%) patients were initially treated conservatively; with only 26 (10%) cases progressing to an operation. Operative interventions were performed laparoscopically in 44% (93/211). Median length of hospital stay was significantly reduced in the conservatively managed group (2 [IQR 1–4] days vs. 3 [2–4], p < 0.001). At 30 days, complications were significantly higher in the operative group (p < 0.001), with no deaths in any group. Of the 159 (32%) patients tested for COVID-19 on admission, only 6 (4%) were positive.ConclusionCOVID-19 has changed the management of acute appendicitis in the UK, with non-operative management shown to be safe and effective in the short-term. Antibiotics should be considered as the first line during the pandemic and perhaps beyond.
Highlights
Acute appendicitis (AA) is the most common general surgical emergency worldwide [1]
Gangrenous appendicitis occurs in 10% of patients, and perforation or abscess is seen in up to one fifth, and both are associated with increased complications [5]
There is the opportunity to observe if the safe and efficient conservative management of AA previously seen in randomised controlled trials and meta-analysis in Europe and the USA is generalisable in the United Kingdom (UK) [21,22,23,24,25,26]. This interim analysis of our study aims to capture the management of AA during the first few weeks of the COVID-19 pandemic lockdown in the UK and to assess the 30-day outcomes [27]
Summary
Acute appendicitis (AA) is the most common general surgical emergency worldwide [1]. Acute appendicitis (AA) is the most common general surgical emergency. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures: as a consequence, conservative management was advised, and open appendicectomy recommended when surgery was unavoidable. Data was collected from 23rd March 2020 (beginning of the UK Government lockdown) to 1st May 2020 and included: patient demographics, COVID status; initial management (operative and conservative); length of stay; and 30-day complications. The median age of this cohort was 35 [26–49.75] years and 233 (47%) of patients were female. Median length of hospital stay was significantly reduced in the conservatively managed group (2 [IQR 1–4] days vs 3 [2,3,4], p < 0.001). Antibiotics should be considered as the first line during the pandemic and perhaps beyond
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