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

  1. Marie Burgard
  2. Floryn Cherbanyk
  3. Konstantinos Nassiopoulos
  4. Sonaz Malekzadeh
  5. François Pugin
  6. Bernhard Egger

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Abstract

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 multi-center 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. Sixty-five patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017–2019). 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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  1. Version published to 10.1371/journal.pone.0249171
  2. ScreenIT

    SciScore for 10.1101/2021.01.23.21250358: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the local Ethics Committee (Project-ID 2020-01676).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: Statistical analysis was performed utilizing the Statistical Package for Social Sciences, version 27.0 (SPSS, IBM, Armonk, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has some limitations. First, the period from March 12 to June 6 was chosen according to the coronavirus lockdown period in Switzerland. Choosing an earlier end date of the study might have led to different results. Second, general practitioners might have treated some patients conservatively without referring them to an emergency department, resulting in a possible underestimation of the total number of patients with appendicitis during this period. However, in our area general practitioners usually send most patients with a suspicion of acute appendicitis to the emergency department in order that they undergo imaging studies to confirm the suspected diagnosis. Thus, we believe that the number of patients who did not present to one of the participating hospitals was rather low. In conclusion, the COVID-19 pandemic induced a decrease in acute appendicitis cases in the EDs, with a significant increase in complicated appendicitis. This phenomenon is most likely explained by symptomatic patients’ substantially delaying medical consultation. The observed increased number of patients with complicated appendicitis was associated with a longer intervention time, longer antibiotic treatment, and a longer hospital stay compared with pre-pandemic patients. Since there might be another lockdown due to COVID-19 or other pandemics in future, it would be helpful to inform patients and general practitioners broadly of the importance of avoiding time delay from onset of symptoms to ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.01.23.21250358v1 on medRxiv