Outcomes Of Acute Appendicitis Research Articles

Acute Appendicitis in Rural KwaZulu-Natal, South Africa

Abstract 
 The Lancet commission on Global Surgery identified a huge global burden of surgical illness which is not adequately treated, as the resources needed to effectively treat these many common surgical conditions are not readily available in many regions. This review aims to provide a comprehensive overview of the epidemiology, management, and outcomes of acute appendicitis in South Africa.
 Methods
 A scoping search was conducted across major electronic databases to identify relevant studies published between January 2000 and December 2023. Articles reporting on the incidence, presentation, diagnostic methods, surgical interventions, and outcomes of acute appendicitis in South Africa were included.
 Results
 The literature review revealed an increasing incidence of acute appendicitis among African patients in South Africa, potentially linked to dietary changes accompanying urbanization. Despite advancements in surgical techniques, open appendectomy remains the primary approach, particularly in public healthcare facilities, indicating disparities in access to laparoscopic surgery. Complications such as wound infections and hospital-acquired pneumonia contribute to prolonged hospital stays, high morbidity, and high mortality. However, outcomes in private healthcare settings demonstrate higher rates of laparoscopic procedures and lower complication rates compared to public institutions.
 Conclusion 
 Acute appendicitis in South Africa presents unique challenges, including disparities in surgical access and outcomes between public and private healthcare sectors. Addressing these challenges requires efforts to improve healthcare infrastructure, enhance surgical training, and promote equitable access to laparoscopic techniques. Collaborative research endeavors and evidence-based interventions are essential for optimizing the management and outcomes of acute appendicitis across diverse socio-economic contexts in South Africa.

Incidence and Outcomes of Acute Appendicitis during the COVID-19 Pandemic

Incidence and Outcomes of Acute Appendicitis during the COVID-19 Pandemic

Operative Management of Acute Appendicitis Was Safe During the COVID-19 Pandemic Shutdown

IntroductionIn the spring of 2020, New York City was one of the first epicenters of the COVID outbreak. In this study, we evaluate the incidence and treatment of appendicitis in two New York City community hospitals during the COVID pandemic. MethodsThis retrospective study focused on the incidence and outcome of acute appendicitis in the adult population (>18 y old) during peak-COVID periods (March 16, 2020,-June 15, 2020) compared to pre-COVID and post-COVID periods. We compared the number of patients who underwent operative versus nonoperative management, patient demographics, length of stay (LOS), complications, and readmission rates within these time periods. Data are presented as mean ± standard deviation (analysis of variance). ResultsFrom January 1, 2020 to December 31, 2020, 393 patients presented with acute appendicitis and 321 (81.7%) were treated operatively, compared to 441 total and 366 treated operatively (83%) in 2019 (P = 0.88). During the COVID outbreak, fewer patients presented with appendicitis (mean 6.9 ± 1 pre-COVID case/week, 4.4 ± 2.4 peak-COVID cases/week and 7.6 ± 0.65 post-COVID cases/week, P = 0.018) with no significant difference in the pre-COVID and post-COVID period. There was no difference in LOS between the pre-, peak-, and post-COVID periods with a median of 1 for all the three, (interquartile range (IQR): 0.8-2, 0.6-2, 0.6-2, respectively, P = 0.43). Additionally, there was no difference in 30-day readmission rates (4.2%, 0%, 3.9%, P = 0.99) and postoperative complications (4.2%, 0%, 2.9%, P = 0.98). ConclusionsDuring peak-COVID, there was a significant reduction in the number of patients who presented with acute appendicitis without a post rebound increase in presentation. Those who presented during peak-COVID were able to undergo operative management safely, without affecting LOS or postoperative complications.

Racial and ethnic variation in emergent surgical care and outcomes during the COVID-19 pandemic: post hoc analysis of an EAST MCT

ObjectivesThe COVID-19 pandemic highlighted concerns regarding the equity of medical care. We evaluated associations between race/ethnicity, timing of hospital presentation and outcomes of acute appendicitis (AP) and acute cholecystitis (AC)...

The Influence of the COVID-19 Pandemic on the Prevalence, Characteristics, Management, and Outcomes of Acute Appendicitis at the Academic Tertiary Center, Jeddah.

Acute appendicitis is the leading cause of acute abdominal pain that requires immediate intervention. Nonetheless, during COVID-19, hospital visits decreased as a result of serious COVID-19 concerns at that time, resulting in a decreased number of diagnosed cases with acute appendicitis due to COVID-19 restriction issues. To report the percentage numbers, characteristics, applied management, and outcomes of patients with acute appendicitis during the COVID-19 pandemic and compare them to pre-COVID-19 cases. A retrospective cohort study included all patients with acute appendicitis in the determined periods "pre-COVID-19" and "during COVID-19" at King Abdul-Aziz Medical City, Academic Tertiary Center, Jeddah, Saudi Arabia. Mean and standard deviation were used, while categorical data were reported as frequencies and percentages. Variables were analyzed by the Chi-squared test, Fisher's exact test, and Mann-Whitney test as appropriate. A total of 298 patients were included. The period of the pre-COVID-19 pandemic had 161 (54%) patients, while 137 (46%) were identified during COVID-19. The number of laparoscopic appendectomies performed during COVID-19 was less than the pre-COVID-19 pandemic of 96 cases (70.1%) vs 133 cases (82.6%) (P=0.0106). Uncomplicated appendicitis was the most commonly reported type of appendicitis in both periods: 113 (82.5%) during COVID-19 vs 135 (83.9%) pre-COVID-19, (P=0.7526). Furthermore, the number of patients who presented to the ER between 24 and 48 hours after the onset of symptoms was similar before and during the pandemic: 111 (68.9%) vs 89 (65%). Overall, we conclude that during the COVID-19 period, there was a reduction in the number of patients presenting with acute appendicitis and a lower chance of undergoing laparoscopic appendectomy due to COVID-19 restrictions. There was also an increase in perforated appendicitis and a decrease in gangrenous appendicitis.

Modified Frailty Index and Brief Geriatric Assessment does not predict prolonged hospitalization in elderly patients undergoing appendectomy due to Acute Appendicitis

Epidemiology and the outcomes of acute appendicitis in elderly people are very different from the younger patients. Aim of this study was to investigate the significance of frailty syndrome in the course of acute appendicitis. All patients over 65 years old who underwent laparoscopic appendectomy between 2013 and 2021 in 2nd Department of General Surgery were included in the study. In our assessment Modified Frailty Index and Brief Geriatric Assessment were performed. In the analyzed period 106 appendectomies were performed in patients over 65 years old. Postoperative complications occurred in 13 patients (12.3%). Prolonged hospitalization (over 3 days) was observed in 48 patients (45.3%). Multivariate analysis showed that every ASA class (OR=2.406; 95% CI 1.089-5.316; p=0.030) and postoperative complication (OR=5.692; 95% CI 1.077-30.073; p=0.041) are risk factors for prolonged hospitalization. Our study identified diabetes (OR=5.956; 95% CI 1.391-25.510; p=0.016) as a risk factor for postoperative complications. According to our study Modified Frailty Index and Brief Geriatric Assessment does not correlate with prolonged hospitalization or higher risk for postoperative complication after appendectomy in elderly people.

Outcomes of acute appendicitis in patients younger than age 4: a descriptive study

BackgroundAcute appendicitis is an infrequent pathology in children under 4 years of age, and its diagnosis is a clinical challenge that can lead to late detection. The intention of this study is to describe the clinical and surgical findings and to explore factors and outcomes associated with appendiceal perforation in patients under 4 years of age with histologically confirmed acute appendicitis. Cross-sectional study of historical data is on patients with a pathologic diagnosis of appendicitis. Clinical, surgical, and pathological variables were described. The relationship between the presence of perforation and associated factors and outcomes was explored using odds ratios (OR) and 95% confidence intervals.ResultsSeventy-five patients were found between 2013 and 2019. Seventy-four cases presented with pain on palpation, 56 (75%) with signs of peritoneal irritation, and 70 (93%) with sepsis on admission to the emergency room. An ultrasound was done on 57 patients (76%), and only 26 (45%) were suggestive of appendicitis. Forty-one (55%) cases were operated on by open surgery and 34 (45%) by laparoscopy. In 61 (81%), they were perforated, and 48 (64%) presented peritonitis. Perforation was associated with increased hospital days (OR = 2.54 [1.60−4.03]), days of antibiotics (OR = 4.40 [2.09−9.25]), and admission to intensive care (OR = 9.65 [1.18−78.57]).ConclusionsAbdominal pain reported by parents, pain on abdominal palpation, and clinical criteria of sepsis on admission to the emergency room are common features. Acute appendicitis complicated by perforation leads to high morbidity due to longer antibiotic treatment, hospitalization days, admission to PICU, and postoperative ileus.

Temporal Trends in the Investigation, Management and Outcomes of Acute Appendicitis over 15 Years in the North of England: A Retrospective Cohort Study

BackgroundAcute appendicitis is a common surgical emergency with an estimated lifetime prevalence of 8.6% for males and 6.7% for females. Despite the frequency of presentation, considerable variation in clinical practice exists. Our study aimed to explore temporal trends in the investigation, treatment and outcomes for patients with appendicitis between 2002 and 2016.MethodsData collected included all patients aged ≥16 years across the NHS trusts in Northern England between 01/01/2002 and 31/12/2016 diagnosed with appendicitis. Patient demographics, co-morbidity and management strategies were included. Outcomes of interest were length of stay and inpatient mortality.ResultsOver a 15 years period, 22,137 patients were admitted with acute appendicitis. A consistent male preponderance (n = 11,952, 54%) was observed, and median age increased over time (2002–2006: 36.4 vs. 2012–2016: 39.5, p < 0.001). Comorbidity of patients also increased (p < 0.001) in recent years. Computed tomography (CT) use increased from 0.8 to 21.9% (p < 0.001) over the study period. Following CT scanning, there was a longer time to theatre (1.22 vs. 0.70 days, p < 0.001), and patients were more frequently managed non-operatively (23.8% vs. 5.7%, p < 0.001). The utilisation of laparoscopic approaches significantly increased from 4.1 to 70.4% (p < 0.001). Laparoscopic patients had a shorter median length of stay (2.97 days) when compared with open surgery (4.44 days) or non-operative (6.19 days) patients. The 30-day mortality rate was 0.33% overall and decreased with time (p = 0.004).ConclusionsCT and laparoscopic surgery are increasingly utilised in the management of appendicitis. Along with other advances in clinical practice, they have led to reduced lengths of stay and mortality.

Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East-a multicentre prospective cohort study.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic had a striking impact on healthcare services in the world. The present study aimed to investigate the impact of the COVID-19 pandemic on the presentation management and outcomes of acute appendicitis (AA) in different centers in the Middle East.MethodsThis multicenter cohort study compared the presentation and outcomes of patients with AA who presented during the COVID-19 pandemic in comparison to patients who presented before the onset of the pandemic. Demographic data, clinical presentation, management strategy, and outcomes were prospectively collected and compared.ResultsSeven hundred seventy-one patients presented with AA during the COVID pandemic versus 1174 in the pre-COVID period. Delayed and complex presentation of AA was significantly more observed during the pandemic period. Seventy-six percent of patients underwent CT scanning to confirm the diagnosis of AA during the pandemic period, compared to 62.7% in the pre-COVID period. Non-operative management (NOM) was more frequently employed in the pandemic period. Postoperative complications were higher amid the pandemic as compared to before its onset. Reoperation and readmission rates were significantly higher in the COVID period, whereas the negative appendicectomy rate was significantly lower in the pandemic period (p = 0.0001).ConclusionDuring the COVID-19 pandemic, a remarkable decrease in the number of patients with AA was seen along with a higher incidence of complex AA, greater use of CT scanning, and more application of NOM. The rates of postoperative complications, reoperation, and readmission were significantly higher during the COVID period.

COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing: A single-center study.

BACKGROUNDSince the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, outcomes and management of many diseases have been affected. Acute appendicitis is a common acute abdomen. The incidence rate is 0.05%-0.5%. Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic. People avoided going to the hospital for fear of being infected. Different countries have different epidemic prevention measures that result in different treatment outcomes. The Chinese government also published some temporary measures in order to prevent the outbreak. AIMTo explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.METHODSPatients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed. Cases were grouped according to admission year. The demographic characteristics, present illnesses, medical history, symptoms and signs, comorbidities, blood test results, imaging data, appendix pathology, and treatment details were compared.RESULTSOverall, 74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019, whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020. Fever, thick appendix, nonsurgical management, and uncomplicated appendicitis (simple or supportive appendicitis) were more common in group 2020 (P < 0.05). Among the nonsurgical management cases, the neutrophil percentage, neutrophil-to-lymphocyte ratio, and recurrence rate were higher in group 2020 (P < 0.05). Among surgically managed cases, there were more cases with gastrointestinal symptoms, peritonitis, ascites in the image, and intraoperative adhesion or ascites in group 2020 (P < 0.05). The white blood cell count, time from diagnosis to surgery, surgical time, and intraoperative blood loss were higher in group 2020 (P < 0.05).CONCLUSIONDuring the COVID-19 pandemic, patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment. For patients who underwent surgical management, the operation was delayed and more difficult during the pandemic. Nevertheless, the hospital stay and the incidence of postsurgical complications did not change.

Mortality in acute appendicitis in Russia

To analyze the causes of mortality in patients with acute appendicitis in Russia. We retrospectively studied mortality in patients with acute appendicitis in the Russian Federation in 2020. We surveyed the hospitals with mortality reported in the electronic database of annual reports to the chief surgeon of the Ministry of Health of the Russian Federation. There were 259 deaths among 150.393 patients with acute appendicitis aged ≥18 years (in-hospital mortality 0.17%). We obtained data about 95.8% (n=248) of lethal cases including 86.3% (n=214) complicated and 13.7% (n=34) uncomplicated forms of disease. Two patients died without surgery (0.8%). Among the deceased, 58.2% (n=145) were men and 41.8% (n=103) were women. Mean patient age was 66.2 years [0.95% CI 64.2-68.1]. The main cause of death in complicated appendicitis was late presentation (after 4.9 days [0.95% CI 4.3-5.4]) that resulted peritonitis and sepsis in 71.5% (n=153) of patients. Cardiovascular diseases were noted in 23.4% (n=50) of cases. A new coronavirus infection was detected in 7.0% (n=15) of patients. However, COVID-19 as a direct cause of death was recognized in 2.8% (n=6) of cases. Other reasons accounted for 2.3% (n=5). In uncomplicated appendicitis, cardiovascular diseases were the main cause of mortality (73.5%, n=25). Peritonitis and sepsis were found in 11.8% (n=4) of cases, COVID-19 - in 5.9% (n=2). Other causes accounted for 8.8% (n=3). Diagnostic, tactical, technical problems and their combination were revealed in 54.4% of lethal outcomes. Mortality from acute appendicitis in the Russian Federation is low, comparable with international data, and mainly associated with delayed treatment and complicated course of disease. However, the impact of diagnostic, tactical and technical errors on the outcome of acute appendicitis is significant.

How doest the retrocecal anatomic localization of the appendix vermiformis affect the prognosis of acute appendicitis today? A comparative prospective study

Appendix vermiformis is found in various anatomical localizations. Localization of the appendix vermiformis has been suggested to affect the clinical findings and outcomes of acute appendicitis. Aimed at investigating the effect of retrocecal localization of appendix vermiformis on the prognosis of acute appendicitis today. This study was started in August 2018 and finished in August 2021. Adult patients of both sexes who were operated in general surgery clinic with a pre-diagnosis of acute appendicitis were included in the study. Anatomic localization of appendix vermiformis were divided into two parts as retrocecal localizations and non-retrocecal localizations. The forms of appendicitis, postoperative complications, and length of hospitalization obtained from retrocecal and non-retrocecal localizations were compared and evaluated. A total of 776 patients were included in the study. Retrocecal localization was found in 15%, and non-retrocecal in 84.9% of the patients. The rate of acute appendicitis was 65.8% in retrocecal localization, 83.1% in non-retrocecal localization, perforated appendicitis at 31.6% in retrocecal localization and 11.2% in non-retrocecal localization. The perforated appendicitis rate was significantly higher in retrocecal localizations (p=.0001). Although postoperative complications were 5.1% in retrocecal appendicitis and 2.4% in non-retrocecal appendicitis, there was no significant difference between them in terms of postoperative complications (p=.105). The mean length of hospital stay was 2.4 days for appendicitis with retrocecal localization and 1.7 days for non-retrocecal localizations. The mean length of hospital stay was also significantly higher in retrocecal localizations (p=.0001). In conclusion, both perforated appendicitis rates and the mean length of hospital stay were higher in appendicitis with retrocecal localization. Therefore, appendicitis with retrocecal localization still negatively affects the prognosis of acute appendicitis today.

Impact of COVID-19 pandemic on outcome of acute appendicitis: a retrospective analysis

Background: Acute appendicitis is the most common abdominal surgical emergency. Lockdown and stay-at-home orders are strategies that were implemented globally during the acute pandemic period of COVID-19 to prevent disease dissemination, health system overload and mortality. However, there are concerns that patients did not seek necessary health care because of these rules.Methods: Retrospective observational study was conducted on patients who presented with acute appendicitis from January 2020 to May 2020. They were classified according to the time of presentation that is before declaration of the state of alarm (pre-COVID-19), and after its declaration (post-COVID-19) in India (24 March 2020). An evaluation was made of demographic variables, complications and duration of hospital stay in both the groups.Results: 45 patients were included, 20 in pre-COVID-19 group and 25 in post-COVID-19 group. In post-COVID-19 group, the interval from onset of symptoms to admission was 65.0 hour, which is significantly longer than the 17.3 hour interval noted in pre-COVID-19 group (p&lt;0.001). The prevalence of complicated appendicitis after the epidemic outbreak was significantly higher than before the outbreak (52% versus 20%, p&lt;0.001).The mean hospital stay was longer in post-COVID-19 group (5.6±5.9 versus 3.2±4.3 days; p=0.041).Conclusions: COVID-19 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Complicated appendicitis was more common in patients with acute appendicitis after the outbreak of COVID-19 pandemic.

SP10.1.3 The presentation, management and outcomes of acute appendicitis: a comparison of patients presenting during the COVID-19 pandemic and those presenting in a pre-COVID-19 period

Abstract Aims This study assesses the impact of COVID-19 on the presentation and management of acute appendicitis (AA). Patients presenting with AA during the first wave of the COVID-19 pandemic are compared to a pre-COVID-19 cohort. Methods Patients admitted to a single acute NHS hospital with AA between April and July in 2019 and 2020 were retrospectively identified. Data on presentation, treatment and outcomes was collected. Results 56 patients were identified in 2019, and 37 in 2020. A greater proportion of patients presented later (&amp;gt;3 days of symptoms) in 2020 (2019=15.6%, 2020=32.4%, p &amp;lt; 0.05). There was no significant difference in the proportion of patients presenting systemically unwell (pyrexial &amp; tachycardic) or with high inflammatory markers (CRP &amp;gt; 50 and white cell count &amp;gt; 15). In 2020, more patients were managed conservatively (2019=7.1%, 2020=35.1%, p &amp;lt; 0.05). Among those who were managed operatively, 75% underwent open appendicectomy in 2020, compared to 7.7% (including cases converted to open from laparoscopic) in 2019. Patients managed operatively during the COVID-19 pandemic had significantly more post-operative complications (2019=17.3%, 2020=50%, p &amp;lt; 0.05). Common post-operative complications in 2020 were abdominal collections (16.7%) and wound infections (12.5%). Median duration of admission was similar (2019=3 days, 2020=2 days) and there was no significant difference in 30-day readmissions (2019=8.9%, 2020=13.5%, p = 0.48). Conclusions AA patients in the COVID-19 pandemic were more likely to present later and were more likely to be managed conservatively or with open appendicectomy. There was a higher rate of post-operative complications for patients in 2020. Duration of stay and readmission rates were similar.

Management and Outcome of Acute Appendicitis in Pediatrics; Our Experience at Queen Rania Al Abdullah Hospital for Children

Objectives: the purpose of our study was to report our experience at Queen Rania Al Abdullah Hospital for Children (QRHC) in the diagnosis and management of acute appendicitis regarding the outcome, complications and hospital stay. Method: A retrospective study was carried out at QRHC by reviewing the medical records of patients who were younger than 14 years that admitted to pediatric surgical ward in the period from Jan 2019 to Jan 2020 with a diagnosis of acute appendicitis. The study included 196 patients, 116 were males and 80 were females with a male to female ratio of 1.45:1. The ages of the patients ranged from 3 years to 14 years with the highest incidence between 10 -13 years. The duration of symptoms ranged from 8 hours to 1 week. The period of hospital stay ranged from 1 to 8 days with a median stay of 2 days. Results: all patients underwent appendectomy, 120 via open approach and 76 by laparoscopy with only 1.53% conversion rate to open (3 cases). 110 cases (56.1%) were non complicated appendicitis while the remaining 86 cases (43.9%) were complicated (perforated appendix), of those 20 cases were less than 5 years old. The rate of negative appendectomy (histopathological normal appendix) was 11.2% (22 cases). Fever was presented in 60 cases (30.6%) and leukocytosis was presented in 130 cases (66.3%).U/S was suggestive of acute appendicitis in 108 patients (55.1%) while the appendix was not visualized in the remaining 88 patients. CT scan was required in 40 patients (20.4%). The overall postoperative complications was 10.7% which occurred in 21 patients, 8 patients (4.1%) developed post-operative ileus , 6 patients (3.1%) complicated with wound infection, 4 cases (2%) developed intra-abdominal abscess and 3 patients (1.5%) had intestinal obstruction. Conclusion: Acute appendicitis is the commonest cause of abdominal surgical emergency in pediatrics and a common cause of misdiagnosed surgical emergency in children. Delayed diagnosis can result in ......

Pattern and Outcome of Acute Appendicitis: Observational Prospective Study from a Teaching Hospital, Addis Ababa, Ethiopia.

BackgroundAcute appendicitis is the most common cause of acute abdomen surgery. Despite its commonness and the abundance of literature on the subject, its diagnosis remains challenging. Delay in intervention results in complications of the process leading to increased morbidity and mortality.MethodologyAn observational prospective cohort study was conducted, and all patients who had undergone appendectomy for a clinical diagnosis of appendicitis were included in the study. Data were analysed using Statistical Package for Social Sciences (SPSS) version 23.ResultsHalf of the study participants were in the age range of 18–25 years with male preponderance (63.9%). The mean duration of symptoms was 51.3 hours. The most common presenting symptom was abdominal pain (98.2%), while right lower quadrant tenderness was the most common sign (93.4%). Abdominal ultrasound was done in 81% of the study population with a sensitivity and specificity of 95.7% and 33.3%, respectively. Three-quarters (74.4%) of the patients had uncomplicated appendicitis, while 1.8% had a grossly normal appendix. None of the appendectomy specimens were sent for pathology. The mean hospital stay was 3.2 days. The morbidity and mortality rate were 3.8% and 0.4%, respectively.ConclusionAcute appendicitis was the most common emergency surgical procedure in the study period. Abdominal ultrasound was used in the majority of the patients as supplementary imaging for the diagnosis of acute appendicitis. Uncomplicated appendicitis took the major share of the intraoperative finding leading to acceptable morbidity and mortality rates.

Where Did All the Appendicitis Go? Impact of the COVID-19 Pandemic on Volume, Management, and Outcomes of Acute Appendicitis in a Nationwide, Multicenter Analysis.

The study objective was to evaluate effects of the COVID-19 pandemic on rates of emergency department (ED) acute appendicitis presentation, management strategies, and patient outcomes. Acute appendicitis is the most commonly performed emergency surgery in the United States and is unlikely to improve without medical or surgical intervention. Dramatic reductions in ED visits prompted concern that individuals with serious conditions, such as acute appendicitis, were deferring treatment for fear of contracting COVID-19. Patients from 146 hospitals with diagnosed appendicitis and arrival between March 2016 and May 2020 were selected. Electronic medical records data were retrospectively reviewed to retrieve patient data. Daily admissions were averaged from March 2016 through May 2019 and compared with March 2020. April-specific admissions were compared across the 5-year pre-COVID-19 period to April 2020 to identify differences in volume, demographics, disease severity, and outcomes. Appendicitis patient admissions in 2020 decreased throughout March into April, with April experiencing the fewest admissions. April 2020 experienced a substantial decrease in patients who presented with appendicitis, dropping 25.4%, from an average of 2030 patients (2016-2019) to 1516 in 2020. An even greater decrease of 33.8% was observed in pediatric patients (age <18). Overall, 77% of the 146 hospitals experienced a reduction in appendicitis admissions. There were no differences between years in percent of patients treated nonoperatively (P = 0.493) incidence of shock (P = 0.95), mortality (P = 0.24), or need for postoperative procedures (P = 0.81). Acute appendicitis presentations decreased significantly during the COVID-19 pandemic, while overall management and patient outcomes did not differ from previous years. Further research is needed focusing on putative explanations for decreased hospital presentations unrelated to COVID-19 infection and possible implications for surgical management of uncomplicated acute appendicitis.Keywords: acute appendicitis, COVID-19, decreasing volumes, multicenter study.

Does the time from symptom onset to surgery affect the outcomes of patients with acute appendicitis? A prospective cohort study of 255 patients.

The objective of this study was to evaluate the impact of operative timing on outcomes of acute appendicitis. This study examined adult patients who had presented to the hospital with acute appendicitis and had undergone appendectomy from December 2017 to February 2019. Time delay and outcomes of perforated and non-perforated appendicitis were compared. Patients were classified into five groups based on the period from symptom onset to operation: group 1, <24 hours; group 2, ≥24 and <48 hours; group 3, ≥48 and <72 hours; group 4, ≥72 and <96 hours; and group 5, ≥96 hours. The five groups were compared, with risk of perforation assessed in particular. A total of 255 patients were included in the analysis. Symptom duration, operative time, and length of postoperative hospital stay (P< .001) were significantly longer in the perforated group (n=49) than in the non-perforated group (n=206). The perforated group also had a higher conversion rate to open procedures (P= .002) and a higher rate of wound infection (P= .034). Group 1 had 53 patients, group 2 had 95 patients, group 3 had 57 patients, group 4 had 32 patients, and group 5 had 18 patients. The incidence of appendiceal perforation and median operative time progressively increased along with symptom duration in the five groups. In multivariate analyses, independent risk factors for appendiceal perforation were male gender (odds ratio=2.33, 95% confidence interval [CI]: 1.07-5.08) and symptom duration ≥48 hours (relative to ≥24 and <48 hours) (odds ratio=4.64, 95%CI: 1.76-12.27). Patients with symptom duration ≥72 hours had a significantly longer operative time than those with symptom duration ≥48 and <72 hours (β=21.38, 95%CI: 5.66-37.11, P= .008). The risk of perforation increased significantly 48 hours after the onset of appendicitis. Symptoms duration ≥72 hours was associated with a longer operative time.

Management and Outcomes of Acute Appendicitis in the Presence of Cirrhosis: A Nationwide Analysis

Best management for acute appendicitis (AA) in adults with liver cirrhosis is controversial and needs more investigation. We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was queried to identify AA patients with no cirrhosis, compensated cirrhosis (CC), and decompensated cirrhosis (DC). Each cohort was further stratified according to the treatment type: nonoperative management, open appendectomy, and laparoscopic appendectomy (LA). Chi-square, ANOVA, and binary regression analyses were used to determine differences between groups and risk factors for mortality and complications, with P < 0.05 considered statistically significant. A total of 108,289 AA patients were analyzed; of those, 304 with CC and 134 with DC were identified. Compared with CC and no cirrhosis, DC patients had significantly higher mortality, higher cost, and longer hospital length of stay. LA is accompanied by higher survival, lower cost, shorter duration of hospitalization, and lower incidence of complications across all groups. We conclude that LA is the best management strategy for AA in cirrhotic patients. Even in decompensated cirrhotics, which are associated with worse clinical outcomes, LA is still a favorable option over open appendectomy and nonoperative management.

Complicated appendicitis: experience from central region of Ghana

Background: Acute appendicitis is a common surgical abdominal emergency. The aim of this study is to determine the incidence, presentation and immediate outcome of acute appendicitis in a new teaching hospital in Cape Coast.Methods: All patients who had surgery for acute appendicitis at the central regional Hospital, cape coast from 1st January 2011 to 25th October 2012 were retrospectively reviewed.Results: During the study period five hundred and four emergency surgical operations were performed. Abdominal emergency operations constituted 81.5% of these emergencies (411/504). Seventy-seven patients who had appendicectomy during the period constituted 18.7% of all abdominal emergencies. Seventy-six of the patients had requisite details for analysis and form the basis of this study. Appendicitis was seen more in the second and third decades of life with male preponderance. Thirty-one (40.3%) had complicated appendicitis (perforated/ ruptured appendicitis and gangrenous appendix). Though appendicitis is uncommon in children less than ten years, more than 80% presented with complicated appendicitis. Only 6.6% of patients were 50 years and above and they all presented with complicated appendicitis. In male patient with appendicitis, 33.3% presented with complicated appendicitis while in females, 57.9% presented with complicated appendicitis. Two (2.6%) patients died in the immediate postoperative period. Conclusions: About one out of five patients who had emergency abdominal surgical operation had acute appendicitis with 40% of them presenting with complicated appendicitis. Complicated appendicitis is more common in females, children less than 10 years and patients 50 years and above. Immediate postoperative mortality is associated with ruptured appendix.