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An effect of the COVID-19 pandemic: significantly more complicated appendicitis due to delayed presentation of patients!

By Marie Burgard, Floryn Cherbanyk, Konstantinos Nassiopoulos, Sonaz Malekzadeh, Francois Pugin, Bernhard Egger

Posted 25 Jan 2021
medRxiv DOI: 10.1101/2021.01.23.21250358

AIMS OF THE STUDY: The novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases and the proportion of complicated appendicitis before and during the COVID 19 pandemic. METHODS: We retrospectively analyzed all data collected from a multicenter database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre and postoperative patient characteristics were evaluated. RESULTS: A total of 306 patients were included in this evaluation. Sixtyfive patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017 to 2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p < 0,001.). Comparing the two groups, significant differences were also noted in the duration of symptoms ( symptoms > 48h in 61% and 26% , p < 0,001), the intervention time ( 77 vs 61 minutes, p = 0,002), length of hospital stay ( hospitalization of > 2 days in 63% and 32%, p < 0.001) and duration of antibiotic treatment ( antibiotics > 3 days in 36% and 24% p = 0.001). CONCLUSIONS: The COVID 19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.

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