Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4349-4359
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4349
Managing acute appendicitis during the COVID-19 pandemic in Jiaxing, China
Yuan Zhou, Lu-Sha Cen
Yuan Zhou, Department of Gastrointestinal Surgery, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing 31400, Zhejiang Province, China
Lu-Sha Cen, Department of Ophthalmology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Zhou Y and Cen LS contributed equally to this manuscript; Zhou Y participated in study design, drafted the manuscript, was involved in data collection, and assisted with data analysis; Cen LS participated in design, was involved in data collection, and supervised the study; All authors have read and approved the final version of the manuscript.
Supported by Jiaxing Key Discipline of Medicine-Oncology (Supporting Subject), No. 2019-zc-11.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the First Hospital of Jiaxing.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict-of-interest statement declared.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Cenlusa2@sina.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lu-Sha Cen, MD, Attending Doctor, Department of Ophthalmology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 310006, Zhejiang Province, China. cenlusa2@sina.com
Received: June 18, 2020
Peer-review started: June 18, 2020
First decision: July 24, 2020
Revised: August 5, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: October 6, 2020
Processing time: 101 Days and 10.7 Hours
Abstract
BACKGROUND

Coronavirus disease 19 (COVID-19) is a global pandemic and has had a profound impact on our routine surgical activities. Acute appendicitis is the most common abdominal emergency worldwide. Therefore, it is highly essential to assess the influence the pandemic has on acute appendicitis.

AIM

To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.

METHODS

We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing, China. Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019. Preoperative management, intraoperative protective measures, and postoperative management were conducted.

RESULTS

After screening, six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group. The results of the nucleic acid test were negative. Of the 76 patients enrolled in the simple group, nine patients received medication therapy, and all others underwent surgery. From this same group, 66 patients were diagnosed with suppurative appendicitis, and one patient was diagnosed with perforated appendicitis after surgery. There were 14 patients in the complex group, for which the postoperative diagnosis indicated perforated appendicitis. The proportion of men with perforated appendicitis was higher than that in 2019 (P < 0.05). The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019 (P < 0.05). The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019 (P < 0.05). The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019 (P < 0.05). Online consultation after discharge was selected in 59 cases (65.6%). No perioperative infection with COVID-19 or long-term postoperative complications were found.

CONCLUSION

The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.

Keywords: COVID-19; Acute appendicitis; Perioperative management; Postoperative management; Perforated appendicitis; Pandemic

Core Tip: This retrospective study evaluated the efficacy of the management of acute appendicitis during the coronavirus disease 19 (COVID-19) pandemic. Emergency preoperative management included appendicitis evaluation and COVID-19 screening. Our research showed that the number of perforated appendicitis with longer chief complaint duration was higher than last year. The shunt used in the simple and complex groups not only supplied appropriate treatment but also reduced the pressure for emergency surgery preparation. Laparoscopic appendectomy was recommended if COVID-19 screening results were negative. No COVID-19 infection occurred. Our management effectively reduced the influence of the pandemic and minimized nosocomial infection risk.