Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2022; 10(29): 10487-10500
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10487
Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis
Sami Akbulut, Adem Tuncer, Zeki Ogut, Tevfik Tolga Sahin, Cemalettin Koc, Emek Guldogan, Ertugrul Karabulut, Elif Seren Tanriverdi, Ali Ozer
Sami Akbulut, Tevfik Tolga Sahin, Cemalettin Koc, Ertugrul Karabulut, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Sami Akbulut, Emek Guldogan, Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Sami Akbulut, Ali Ozer, Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Adem Tuncer, Zeki Ogut, Department of Surgery, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Elif Seren Tanriverdi, Department of Medical Microbiology, Inonu University Medical Faculty, Malatya 44280, Turkey
Author contributions: Akbulut S, Tuncer A, Ogut Z, Tanriverdi ES, and Koc C collected data; Akbulut S and Ozer A performed statistical analysis; Akbulut S and Sahin TT wrote the manuscript; Akbulut S, Sahin TT, and Yilmaz S contributed to project development and reviewed the final version.
Institutional review board statement: This study was reviewed and approved by the Inonu University institutional review board for non-interventional studies (2021/2293).
Informed consent statement: Verbal and written consents were obtained from all patients who underwent appendectomy.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: There are no additional data available for this study.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, FACS, MD, PhD, Professor, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10 Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Received: July 25, 2022
Peer-review started: July 25, 2022
First decision: August 7, 2022
Revised: August 16, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: October 16, 2022
Research background

Although emergency procedures were allowed during the coronavirus disease 2019 (COVID-19) pandemic provided that necessary precautions were taken in the operating theatre and inpatient wards, it was believed that there were serious disruptions in the management of patients with acute appendicitis (AAp).

Research motivation

AAp management is critical because AAp is the most common cause of acute abdominal pain, and appendectomy is the most frequent emergency procedure.

Research objectives

The present study aimed to comparatively evaluate the impact of the COVID-19 pandemic to the pre-pandemic period regarding patients who underwent appendectomy for AAp in terms of negative appendectomy and perforation rates. Our secondary aim was to evaluate the impact of the COVID-19 pandemic on the hospital admission rates of patients with AAp.

Research methods

Demographic, clinical, and histopathological characteristics of 223 patients (COVID-19 group) who underwent appendectomy with a preliminary diagnosis of AAp between March 2020 and July 2021 were compared with 154 patients (pre-COVID-19 group) who underwent appendectomy with the same indication between October 2018 and March 2020.

Research results

There was a 44.8% increase in the number of patients admitted to our hospital with a presumed diagnosis of AAp during the pandemic. Significant differences were found between pre-COVID-19 and COVID-19 groups in terms of procedures performed on the weekdays or weekends [odds ratio (OR): 1.76; P = 0.018], presence of AAp findings on ultrasonography (OR: 15.4; P < 0.001), confirmation of AAp in the histopathologic analysis (OR: 2.6; P = 0.003), determination of perforation in the appendectomy specimen (OR: 2.2; P = 0.004), the diameter of the appendix (P < 0.001), and hospital stay (P = 0.003).

Research conclusions

The results of our study suggest that the perforated AAp rates increased, which led to prolonged hospital stays during the COVID-19 pandemic. The number of patients treated with AAp increased during the pandemic, which is attributed to the shift of roles of the two state hospitals in our city. Fortunately, although the rate of complicated AAp increased, this did not increase our postoperative complication rates. Therefore, we can conclude that during global catastrophes such as the COVID-19 pandemic more complicated forms of the diseases such as AAp can be seen.

Research perspectives

This study has shown that even diseases that require emergency management, such as AAp, can be ignored during the COVID-19 pandemic. It is known that this situation is directly related to both patient behavior and the increased workload of healthcare professionals. The most important way to overcome this problem is to learn from the pandemic process, implement preventive measures properly, and create social awareness.