Retrospective Study
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World J Clin Cases. Jan 21, 2022; 10(3): 820-829
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.820
COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing: A single-center study
Peng Zhang, Qian Zhang, Hong-Wei Zhao
Peng Zhang, Qian Zhang, Hong-Wei Zhao, Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Author contributions: Zhang P and Zhang Q contributed equally to this work; Zhang P and Zhang Q designed the research study; Zhang P, Zhang Q and Zhao HW performed the research; Zhang Q and Zhao HW contributed new reagents and analytic tools; Zhang P and Zhang Q analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Beijing Tsinghua Changgung Hospital institutional review board.
Informed consent statement: Waiver of informed consent.
Conflict-of-interest statement: The authors declared that they have no conflicts of interest to this work.
Data sharing statement: The consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low.
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: Peng Zhang, MD, Attending Doctor, Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing 102218, China. 13911025919@139.com
Received: July 26, 2021
Peer-review started: July 26, 2021
First decision: October 25, 2021
Revised: October 27, 2021
Accepted: December 23, 2021
Article in press: December 23, 2021
Published online: January 21, 2022
Processing time: 173 Days and 10.8 Hours
ARTICLE HIGHLIGHTS
Research background

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, the outcomes and management of acute appendicitis have been affected. Different countries have different epidemic prevention measures that result in different treatment outcomes. The aim of this research was to explore whether the COVID-19 pandemic changed the management and outcomes of acute appendicitis in Beijing.

Research motivation

How did the COVID-19 pandemic change the management and outcomes of acute appendicitis in Beijing?

Research objectives

Explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in Beijing.

Research methods

Patients with acute appendicitis treated in Beijing Tsinghua Changgung Hospital from February to June 2019 and February to June 2020 were reviewed retrospectively. All patients were treated surgically or non-surgically according to their decisions. The demographics, symptoms, signs, laboratory parameters, imaging results, operation details, uncomplicated appendicitis rate, complications rate and recurrence rate were collected. SPSS 16.0 (IBM, United States) was used to analyze all results. T-test was used for continuous variables, while the chi-square test was used for the frequency data. A P < 0.05 indicated a statistically significant difference.

Research results

There were 74 patients who received non-surgical treatment and 113 patients who underwent surgical treatment in group 2019 vs 159 patients with non-surgical treatment and 26 patients with surgical treatment in group 2020. Higher fever rate, thicker appendix diameter, a higher rate of non-surgical management, and a higher rate of uncomplicated appendicitis were observed in group 2020 than in group 2019. Among the non-surgical management cases, the neutrophil percentage, neutrophil-to-lymphocyte ratio, and the recurrence rate were higher in group 2020. There were more cases with gastrointestinal symptoms and peritonitis in group 2020. Higher white blood cell count, a higher rate of ascites in the image, longer time from diagnosis to surgery, longer surgical time, higher intraoperative blood loss and a higher rate of intraoperative adhesion or ascites were observed in group 2020 compared to group 2019.

Research conclusions

During the COVID-19 pandemic, patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for non-surgical treatment. For patients who underwent surgical management, the operation was delayed and more difficult during the pandemic. The hospital stay and the incidence of post-surgical complications did not change. The complex preoperative examination can ensure the safety of laparoscopic appendectomy, which leads to a better postoperative outcomes.

Research perspectives

This study has some limitations. As this was a retrospective study, it was inevitably biased. This was a single-center study with small sample size. The follow-up time during the pandemic was short. Therefore, the results need to be further confirmed by large case studies or RCT studies.