Evaluation of the appendectomy cases performed under emergency conditions during the COVID-19 pandemic and discussed with the pathology reports

BACKGROUND: The aim of this study is to examine the cases underwent appendectomy during the COVID-19 pandemic and to discuss the pathology reports of patients.
METHODS: During the COVID-19 pandemic, the pathological reports of the appendectomy materials of 588 patients over the age of 15 who applied to the emergency department between January 1, 2020, and June 1, 2021, were examined. A total of 565 patients with a diagnosis of acute (AA), subacute (SA), or perforated appendicitis (PA) were included and divided into three groups according to diagnosis. Twenty-three patients were excluded from the study due to other pathologies. The age, gender, duration of pain, ASA score, operational technique, operation time, Clavien-Dindo score, hospitalization time, post-operative complications, pre- and post-operative PCR and thoracic tomography findings in suspected cases of COVID-19, and laboratory and radiological findings of patients were retrospectively analyzed.
RESULTS: Of 565 patients diagnosed with appendicitis, 464 (82.1%) had AA, 35 (6.2%) SA, and 66 (11.7%) PA. The median age of the PA group was higher than in the AA group (p=0.0139). The incidence of diabetes mellitus in the PA group and of asthma in the SA group were highest among other groups (p=0.004 and 0.0037, respectively). The duration of pain was longer in the SA and PA groups than the AA group (p<0.0001), therefore, the patients applied to hospital later than the acute group. The rate of thorax CT-positive scans was 1.6% in patients suspected for COVID-19 (p=0.066). While laparoscopic surgery was preferred over 70% in all groups, the rate of conventional surgery (21.1%) in the AA group was highest and of transition from laparoscopic to open surgery was highest in the PA group (10.6%) (p<0.0001). Hospitalization duration was longest in the PA group (p<0.0001).
CONCLUSION: COVID-19 pandemic not only changes all routines of social life but also complicates the treatment and manage-ment of cases with AA symptoms applied to hospital under emergency conditions. Follow-up of the appendectomy specimen is crucial in terms of excluding other pathologies.

COVID-19 pandemisi sürecinde acil þartlarda yapýlan apendektomi olgularýnýn patoloji raporlarý eþliðinde deðerlendirilmesi

AMAÇ: Bu çalýþmanýn amacý COVID-19 pandemisi sýrasýnda apendektomi yapýlan olgularý incelemek, hastalarýn patoloji raporlarýný tartýþmaktýr. GEREÇ VE YÖNTEM: COVID-19 pandemisi sýrasýnda 1 Ocak 2020–1 Haziran 2021 tarihleri arasýnda acil servise baþvuran 15 yaþ üstü 588 hastanýn apendektomi materyallerinin patolojik raporlarý incelendi. Akut (AA), subakut (SA) veya perfore apandisit (PA) tanýlý 565 hasta çalýþmaya dahil edildi ve tanýlarýna göre üç gruba ayrýldý. Yirmi üç hasta, diðer patolojiler nedeniyle çalýþma dýþý býrakýldý. Hastalarýn yaþ, cinsiyet, aðrý süresi, ASA skoru, ameliyat tekniði, ameliyat süresi, Clavien-Dindo skoru, hastanede yatýþ süresi, ameliyat sonrasý komplikasyonlar, þüpheli COVID-19 olgularýnda ameliyat öncesi ve sonrasý PCR ve torasik tomografi bulgularý, laboratuvar ve radyolojik bulgularý geriye dönük olarak incelendi.
BULGULAR: Apandisit tanýsý alan 565 hastanýn 464’üne (%82.1) AA, 35’ine (%6.2) SA ve 66’sýna (%11.7) PA tanýsý kondu. PA grubunun medyan yaþý AA grubuna göre daha fazlaydý (p=0.0139). PA grubunda diabetes mellitus ve SA grubunda astým insidansý diðer gruplar arasýnda en yüksekti (sýrasýyla p=0.004 ve 0.0037). SA ve PA gruplarýnda aðrý süresi AA grubuna göre daha uzundu (p<0.0001), bu nedenle hastalarýn akut gruba göre hastaneye daha geç baþvurduðu belirlendi. COVID-19 þüphesi olan hastalarda toraks BT taramasý pozitif olanlarýn oraný %1.6 idi (p=0.066). Tüm gruplarda %70’in üzerinde laparoskopik cerrahi tercih edilirken, AA grubunda en fazla konvansiyonel cerrahi (%21.1) yapýldýðý ve PA grubunda la-paroskopik cerrahiden açýk cerrahiye geçiþ oranýnýn diðer gruplara kýyasla en yüksek (%10.6) olduðu tespit edildi (p<0.0001). Hastanede kalýþ süresi PA grubunda en uzundu (p<0.0001).
TARTIÞMA: COVID-19 pandemisi sadece sosyal hayatýn tüm rutinlerini deðiþtirmekle kalmamýþ, acil þartlarda hastaneye baþvuran AA semptomlu olgularýn tedavisini ve yönetimini de zorlaþtýrmýþtýr. Apendektomi piyeslerinin takibi diðer patolojilerin dýþlanmasý açýsýndan önemlidir.