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Emergency appendicectomy during COVID-19 pandemic - A single UK centre experience
Hrishikesh Salgaonkar1, Adebimpe Aladeojebi1, David Murcott1
1Department of Surgery, University Hospital North Midlands, Stoke-on-Trent, United Kingdom.
Insights
Emergency appendectomies during the COVID-19 pandemic were safely performed with careful planning and strict protocols. Outcomes were comparable to pre-pandemic levels, with minimal risk of Novel coronavirus infection spread.
Area of Science:
- Surgery
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic severely impacted healthcare, leading to reduced elective surgeries and modified emergency care.
- Limited data existed on surgical outcomes during the pandemic's peak.
Purpose of the Study:
- To evaluate the outcomes of emergency appendectomies performed during the COVID-19 pandemic.
- To compare surgical outcomes with a pre-pandemic control group.
Main Methods:
- Prospective data collection from 132 patients undergoing emergency appendectomy during the peak pandemic (March-June 2020).
- Comparison with 206 patients from the same period in 2019.
- Analysis of patient demographics, surgical management, and postoperative outcomes.
Main Results:
- Laparoscopic appendicectomy rates were high in both pandemic (84.4%) and control (96.7%) cohorts.
- Mean length of stay and early complications were similar, except for a higher rate of surgical site infections (p=0.02) in the pandemic cohort.
- One mortality occurred in the pandemic cohort.
Conclusions:
- Emergency appendicectomy can be safely performed during pandemics with appropriate planning and protocols.
- Conservative management is an option, but surgery remains necessary for some acute appendicitis cases.
- Further prospective randomized studies are warranted to confirm these findings.
Abstract:
Background - In December 2019 following an outbreak of Novel coronavirus infection (COVID-19) in Wuhan, China, it spread rapidly overwhelming the healthcare systems globally. With little knowledge of COVID-19 virus, very few published reports on surgical outcomes; hospitals stopped elective surgery, whilst emergency surgery was offered only after exhausting all conservative treatment modalities. This study presents our experience of outcomes of emergency appendectomies performed during the pandemic. Methods - Prospectively we collected data on 132 patients in peak pandemic period from 1st March to 5th June 2020 and data compared with 206 patients operated in similar period in 2019. Patient demographics, presenting symptoms, pre-operative events, investigations, surgical management, postoperative outcomes and complications were analysed. Results - Demographics and ASA grades of both cohorts were comparable. In study cohort 84.4% and 96.7% in control cohort had laparoscopic appendicectomy. Whilst the study cohort had 13.6% primary open operations, control cohort had 5.3%. Mean length of stay and early post-operative complications (<30 days) were similar in both cohorts apart from surgical site infections (p = 0.02) and one mortality in study cohort. Conclusion - In these overwhelming pandemic times, although conservative treatment of acute appendicitis is an option, a proportion of patients will need surgery. Our study shows that with careful planning and strict theatre protocols, emergency appendicectomy can be safely offered with minimal risk of spreading COVID-19 infection. These observations warrant further prospective randomised studies. Keywords - appendicectomy, COVID-19, Coronavirus, emergency surgery, laparoscopy.
