Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10487
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
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).
AAp management is critical because AAp is the most common cause of acute abdominal pain, and appendectomy is the most frequent emergency procedure.
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.
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.
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).
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.
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.