Changes in the frequency, presentation and surgical outcomes of complicated appendicitis during the pandemic

OBJECTIVE: Coronavirus Disease 2019 (COVID-19) has affected every aspect of human life and all health care systems globally. The aim of this study was to investigate the effect of COVID-19 pandemic on the frequency, presentation and surgical outcomes of complicated appendicitis.
METHODS: Patients who underwent appendectomy for acute appendicitis one year before and one year after the declaration of the pandemic were investigated. Demographics and diagnostic findings as well as surgical and histopathological outcomes were recorded and statistically analyzed.
RESULTS: The study group of 409 patients was composed of 241 cases in the pre-pandemic group and 168 cases in the pandemic group revealing that the weekly total number of appendectomies decreased during the pandemic [pre-pandemic, median (IQR): 5 (3–6); pandemic, median (IQR): 3 (2–5); p=0.005]. The pandemic group was significantly associated with a longer time from emergency department admission to hospitalization, increased mean blood C-reactive protein levels and increased rate of postoperative complications (p=0.024, p=0.038 and p=0.004, respectively). Most importantly, pathological examinations revealed a higher number of complicated appendicitis cases in the pandemic group when compared to the pre-pandemic group [26 (15.5%) vs. 19 (7.9%), respectively] which corresponded to a 2.1-fold higher risk of being diagnosed with complicated appendicitis during the pandemic [OR: 2.1 (95% CI: 1.1–4.1), p=0.024].
CONCLUSION: While fewer appendectomies were performed during the pandemic, the incidence of complicated appendicitis and postoperative complications increased considerably.

Pandeminin komplike apandisit sýklýðý, bulgularý ve cerrahi sonuçlarý üzerindeki etkileri

Amaç: Koronavirüs Hastalýðý 2019 (COVID-19), küresel olarak tüm dünyada insanlarýn yaþamýný ve farklý ülkelerin saðlýk sistemlerini etkilemiþtir. Bu çalýþmanýn amacý, COVID-19 pandemisinin komplike apandisitin sýklýðý, bulgularý ve cerrahi sonuçlarý üzerindeki etkisini araþtýrmaktýr.
Yöntemler: Pandemi ilanýndan bir yýl önce ve bir yýl sonra akut apandisit nedeniyle apendektomi uygulanan hastalar incelendi. Demografik ve tanýsal bulgularýn yaný sýra, cerrahi ve histopatolojik sonuçlar kaydedilerek istatistiksel olarak analiz edildi.
Bulgular: 409 hastadan oluþan çalýþma grubu, pandemi öncesi grupta 241 vaka ve pandemi grubunda 168 vakadan oluþmakta olup, pandemi sýrasýnda haftalýk toplam apendektomi sayýsýnýn azaldýðý görülmektedir [pandemi öncesi, medyan (IQR): 5 ( 3-6); pandemi, medyan (IQR): 3 (2-5); p=0.005]. Pandemi grubundaki hastalarda acil servise baþvurudan hastaneye yatýþa kadar geçen sürede, ortalama kan C-reaktif protein seviyelerinde ve postoperatif komplikasyon oranlarýnda anlamlý þekilde artýþ izlenmiþtir (sýrasýyla, p=0.024, p=0.038 ve p=0.004). Apendektomi materyalinin patolojik incelemeleri pandemi öncesi grupla karþýlaþtýrýldýðýnda, pandemi grubunda artmýþ sayýda komplike apandisit vakasý olduðu ortaya çýkmýþ, [sýrasýyla 26 (%15,5) ve 19 (%7,9)] pandemi döneminde komplike apandisit görülme riski 2,1 kat artmýþtýr [OR: 2.1 (%95 CI: 1.1-4.1), p=0.024].
Sonuç: Pandemi sürecinde daha az sayýda apendektomi yapýlmasýna raðmen, komplike apandisit insidansý ve postoperatif komplikasyonlar önemli ölçüde artmýþtýr. (NCI-2023-11-1)