Türkiye’de COVID-19 pandemi döneminde akut apandisit: Klinik uygulamalarda, taný ve tedavi modalitelerinde deðiþiklikler, geriye dönük kohort çalýþmasý

AMAÇ: COVID-19 pandemisi, saðlýk sistemlerinde ve acil cerrahi müdahalelerde önemli deðiþikliklere neden olmuþtur. Bu çalýþmada, acil servislere baþvuran akut apandisitli hastalarý inceleyerek pandemi öncesi ve pandemi döneminde taný, tedavi ve tedavi sonrasý süreçleri karþýlaþtýrýlmýþ ve pandeminin akut apandisit tedavisini nasýl etkilediðini araþtýrýlmýþtýr.
GEREÇ VE YÖNTEM: Klinik ve/veya radyolojik olarak akut apandisit tanýsý almýþ 18 yaþýndan büyük hastalar, pandemi öncesi dönem (1 Ocak–30 Nisan 2019) ve pandemi dönemi (1 Ocak–30 Nisan 2020) olarak iki gruba ayrýlmýþtýr. Çalýþmada ameliyat öncesi görüntüleme yöntemleri, plastron apandisit/apse varlýðý, konservatif/cerrahi yaklaþým, verilen anestezi türü, laparoskopik/açýk cerrahi yaklaþým, baðýrsak rezeksiyonu oranlarý, dren yerleþtirme oranlarý ve ameliyat sonrasý komplikasyon varlýðý karþýlaþtýrýlmýþtýr.
BULGULAR: Ýki çalýþma grubu için 69 merkezden 8972 hasta incelenmiþtir, 4582 hasta pandemi öncesi dönemde ve 4234 hasta pandemi döne-minde ameliyat edilmiþtir. Pandemi döneminde hastalarýn %63.6’sýna açýk cerrahi, %34.4’üne ise laparoskopik cerrahi uygulanmýþtýr. Pandemi öncesi dönemde 60 hasta (%1.3) ameliyatsýz takip talebinde bulunurken, pandemi döneminde 94 hasta (%2.2) bunu talep etmiþtir. Hastalarýn durumlarý kendi istekleri dýþýnda deðerlendirildiðinde, pandemi öncesinde 114 hasta (%2.4) ve pandemi sýrasýnda 163 hasta (%3.8) ameliyatsýz takip almýþtýr. TARTIÞMA: Çalýþmamýz, COVID-19 ile ilgili kýsýtlamalarýn uygulanmasý ile akut apandisit þiddeti arasýnda doðrudan bir iliþki göstermemiþtir. CO-VID-19 döneminde ameliyatsýz tedavi oranlarý artmýþ olsa da, COVID-19 kriz döneminde hem komplike hem de komplike olmayan apandisit insi-danslarý benzerdir. Bu bilgiler göz önüne alýndýðýnda, apandisit teþhisi konan hastalarda ameliyatsýz yönetim uygulanabilir.

Acute appendicitis during coronavirus disease 2019 in Türkiye: Changes in clinical approach, treatment, and diagnosis modalities: A retrospective and cohort study

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has resulted in major changes in health-care systems and emer-gency surgical interventions. Here, we examined patients with acute appendicitis who presented to emergency departments and com-pared diagnosis, treatment, and post-treatment processes before and during the pandemic period and investigated how the pandemic affected management of acute appendicitis.
METHODS: A national, multicenter, and cohort study model was designed that included patients older than 18 years of age diag-nosed with acute appendicitis clinically and/or radiologically, with patients compared before (pre-pandemic period: January 1–April 30, 2019) and after (pandemic period: January 1–April 30, 2020) the pandemic. Our investigation included comparisons of pre-operative imaging methods, presence of plastron appendicitis/abscess, conservative/surgical approach, type of anesthesia given, laparoscopic/open surgical approach, bowel resection rates, drain insertion rates, and presence of post-operative complications
RESULTS: For the two study groups, 8972 patients from 69 centers were examined, with 4582 patients operated in the pre-pan-demic period and 4234 patients operated in the pandemic period. During the pandemic period, 63.6% of patients underwent open surgery, whereas 34.4% had laparoscopic surgery. Although 60 patients (1.3%) requested non-operative follow-up in the pre-pandemic period, 94 patients (2.2%) requested this in the pandemic period. When conditions of patients were evaluated regardless of their own wishes, 114 patients (2.4%) before and 163 patients (3.8%) during the pandemic received non-operative follow-up.
CONCLUSION: Our study did not show the direct correlation between the application of COVID-19-related restrictions and the severity of acute appendicitis. Although non-operative management rates have been increased during the COVID-19 period, the incidences of both complicated and the uncomplicated appendicitis were similar during the COVID-19 crisis period. Given this infor-mation non-operative management can be employed for patients diagnosed with appendicitis.