The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study

Javanmard-Emamghissi, H.; Boyd-Carson, H.; Hollyman, M.; Doleman, B.; Adiamah, A.; Lund, J. N.; Clifford, R.; Dickerson, L.; Richards, S.; Pearce, L.; Cornish, J.; Hare, S.; Lockwood, S.; Moug, S. J.; Tierney, G. M.; The COVID: HAREM (Had Appendicitis, Resolved/Recurred Emergency Morbidity/Mortality) Collaborators Group

Abstract

Background
Acute appendicitis (AA) is the most common general surgical emergency. Early laparoscopic appendicectomy is the gold-standard management. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures: as a consequence, conservative management was advised, and open appendicectomy recommended when surgery was unavoidable. This study describes the impact of the first weeks of the pandemic on the management of AA in the United Kingdom (UK).

Methods
Patients 18 years or older, diagnosed clinically and/or radiologically with AA were eligible for inclusion in this prospective, multicentre cohort study. Data was collected from 23rd March 2020 (beginning of the UK Government lockdown) to 1st May 2020 and included: patient demographics, COVID status; initial management (operative and conservative); length of stay; and 30-day complications. Analysis was performed on the first 500 cases with 30-day follow-up.

Results
The patient cohort consisted of 500 patients from 48 sites. The median age of this cohort was 35 [26–49.75] years and 233 (47%) of patients were female. Two hundred and seventy-one (54%) patients were initially treated conservatively; with only 26 (10%) cases progressing to an operation. Operative interventions were performed laparoscopically in 44% (93/211). Median length of hospital stay was significantly reduced in the conservatively managed group (2 [IQR 1–4] days vs. 3 [2–4], p [less than] 0.001). At 30 days, complications were significantly higher in the operative group (p [less than] 0.001), with no deaths in any group. Of the 159 (32%) patients tested for COVID-19 on admission, only 6 (4%) were positive.

Conclusion
COVID-19 has changed the management of acute appendicitis in the UK, with non-operative management shown to be safe and effective in the short-term. Antibiotics should be considered as the first line during the pandemic and perhaps beyond.

Citation

Javanmard-Emamghissi, H., Boyd-Carson, H., Hollyman, M., Doleman, B., Adiamah, A., Lund, J. N., …The COVID: HAREM (Had Appendicitis, Resolved/Recurred Emergency Morbidity/Mortality) Collaborators Group. (2021). The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study. Techniques in Coloproctology, 25(4), 401–411. https://doi.org/10.1007/s10151-020-02297-4

• Journal Article Type: Article
• Acceptance Date: Jun 9, 2020
• Online Publication Date: Jul 15, 2020
• Publication Date: 2021-04
• Deposit Date: Nov 29, 2020
• Publicly Available Date: Dec 1, 2020
• Journal: Techniques in Coloproctology
• Print ISSN: 1123-6337
• Electronic ISSN: 1128-045X
• Publisher: Springer Nature
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 4
• Pages: 401–411
• DOI: https://doi.org/10.1007/s10151-020-02297-4
• Keywords: Surgery; Gastroenterology
• Public URL: https://nottingham-repository.worktribe.com/output/5075729
• Publisher URL: https://link.springer.com/article/10.1007%2Fs10151-020-02297-4
• Additional Information: Received: 9 June 2020; Accepted: 5 July 2020; First Online: 15 July 2020; Change Date: 25 September 2020; Change Type: Correction; Change Details: Unfortunately, few of the collaborators names were incorrectly published in the original publication.; : ; : The authors declare that they have no conflict of interest.; : This is an observational study; therefore, no ethics approval was required.; : For this type of study, formal consent is not required.