Comparative analysis of the management of acute appendicitis between the normal period and COVID-19 pandemic

BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency. There is no adequate information to evaluate the effects of the COVID-19 pandemic on acute appendicitis and its surgical management. The present comparative study reports successful appendectomy and infection control in patients with appendicitis during the COVID-19 pandemic and last year covering the same period.
METHODS: This retrospective observational study was conducted in acute appendicitis-treated patients from 13.03.19 to 13.05.19 and from 13.03.20 to 13.05.20, respectively.
RESULTS: This study included 150 patients (110 patients in 2019; 40 patients in 2020 (during COVID-19 pandemic)). The patients were named as Group A (Normal period) and Group B (Pandemic period), respectively. The groups were comparable as there was no significant difference between the mean age, mean BMI, and mean length of stay. There is a significant difference between the comorbidities of Group A and Group B (p=0.033). There was no significant difference between the laboratory and radiological findings of Group A and Group B. There was a significant difference between the perforation number of Group A and Group B (p=0.029). There was no significant difference between the needs of ICU and conversion from laparoscopic to conventional appendectomy of Group A and Group B.
CONCLUSION: The findings obtained in this study suggest that late admission to the hospital caused complicated cases and made acute appendicitis management more difficult during the pandemic period, which was already a troubling period. During the COVID-19 pandemic, the principles applied to emergency surgery for infected patients should be applied to both suspected and confirmed cases.

Akut apandisit yönetiminin normal dönemde ve COVID-19 pandemisi esnasýnda karþýlaþtýrmalý analizi

AMAÇ: Bilindiði üzere akut apandisit, en sýk acil abdominal cerrahi nedenidir. COVID-19 pandemisinin akut apandisit ve cerrahi tedavisi üzerindeki etkilerini deðerlendirmek amacýyla yapýlan çalýþmalar kýsýtlýdýr ve yeterli bilgi mevcut deðildir. Mevcut karþýlaþtýrmalý çalýþma, COVID-19 pandemisi sýrasýnda ve geçen yýl ayný periyodu kapsayan dönemde apendektomi ameliyatý geçiren hastalarýn apendektomi sonuçlarýný ve enfeksiyon kontrolünü bildirmeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Gerçekleþtirilen geriye dönük gözlemsel çalýþma, karþýlaþtýrmalý olarak 13.03.19–13.05.19 ve 13.03.20–13.05.20 tarihleri arasýnda akut apandisit nedeniyle ameliyat edilen hastalar üzerinde gerçekleþtirildi.
BULGULAR: Çalýþmaya 150 hasta (2019’da 110 hasta; 2020’de 40 hasta [COVID-19 pandemi sýrasýnda]) dahil edildi ve hastalar sýrasýyla Grup A (Normal dönem) ve Grup B (Pandemi dönemi) olarak isimlendirildi. Ortalama yaþ, ortalama VKÝ ve ortalama kalýþ süresi arasýnda anlamlý bir fark olmadýðý için istatistiksel olarak kýyaslanabilir gruplar olarak deðerlendirildi. Grup A ve Grup B komorbiditeleri arasýnda anlamlý fark gözlendi (p=0.033). Grup A ve Grup B’nin laboratuvar deðerleri ve radyolojik bulgularý arasýnda anlamlý bir fark yoktu. Grup A ile Grup B’nin perforasyon sayýsý arasýnda anlamlý fark tespit edildi (p=0.029). Grup A ve Grup B’nin yoðun bakým ihtiyacý ile laparoskopiden konvansiyonel apendektomiye geçiþ sayýlarý arasýnda anlamlý bir fark yoktu.
TARTIÞMA: Çalýþmamýzda da görüldüðü üzere, hastaneye geç baþvuru, komplike olgulara neden olmuþ ve zaten sýkýntýlý bir dönem olan pandemi sürecinde, akut apandisit yönetimini daha da zorlaþtýrmýþtýr. COVID-19 salgýný sýrasýnda, acil cerrahide uygulanan ilkeler hem þüpheli hem de doðrulanmýþ COVID-19 olgularýna uygulanmalýdýr.