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We can reduce negative paediatric appendicectomy rate: A cohort study
Maitreyi Patel1, Joel Joy Thomas1, Haschmatullah Sarwary1
1Department of General Surgery, Queen's and King George's Hospital, Barking, Havering and Redbridge University NHS Trust, United Kingdom.
Insights
During the COVID-19 pandemic, the negative appendicectomy rate in children dropped to zero, a significant decrease from 17.14% in 2019. This improvement in pediatric appendicitis surgery outcomes was linked to enhanced imaging and senior surgeon involvement.
Area of Science:
- Pediatric Surgery
- Epidemiology
- Public Health
Background:
- Appendicitis is a common pediatric surgical emergency.
- The COVID-19 pandemic prompted changes in surgical practices, potentially affecting appendicitis treatment.
- A decrease in negative appendicectomy rates was anticipated due to stricter surgical criteria.
Purpose of the Study:
- To evaluate the negative appendicectomy rate in children under 16 during the first COVID-19 wave.
- To compare this rate with the same period in 2019 to identify significant differences.
Main Methods:
- Retrospective analysis of pediatric appendicectomy cases (age <16) from March 23 to June 30, 2020.
- Comparison of negative appendicectomy rates with data from the same period in 2019.
- Statistical analysis using t-tests and chi-squared/Fisher's exact tests (p<0.05 significance).
Main Results:
- Zero negative appendicectomies were performed during the pandemic period (23 patients), compared to 17.14% in 2019 (35 patients).
- Laparoscopic appendicectomy rates decreased from 54.29% in 2019 to 17.39% in 2020.
- No significant differences were observed in hospital stay, complication rates, or re-admission rates between the two periods.
Conclusions:
- The study reports the lowest incidence of negative appendicectomy during the pandemic, attributed to increased use of preoperative imaging and early senior surgeon involvement.
- Despite an increase in complicated appendicitis cases during the pandemic, clinical outcomes did not worsen.
Background:
Appendicitis accounts for the most frequent surgical emergencies in childhood. The guidance from the Royal College of Surgeons and poor post operative outcomes in surgical patients during the pandemic, it would be expected that only children who had clinical signs of appendicitis and were unwell, would have undergone surgery. Hence, the negative appendicectomy rate during the pandemic should have decreased.The aim of this retrospective study was to assess the rate of negative appendicectomy amongst children <16 years of age during the first wave of the pandemic, from the announcement of the lockdown and determine if there was a true difference by comparing the rate with the same time period in 2019.
Material And Methods:
Data of all children aged<16 years who were operated for appendicitis between 23/3/2020 and 30/06/2020 was collected retrospectively and compared with that of children operated during the same time period in 2019 for the rate of negative appendicectomy.Data were analysed using the two-tailed t-test for continuous data and χ2 or Fishers exact tests for categorical data with p value of <0.05 considered significant.
Results:
Twenty three paediatric patients presenting with acute appendicitis underwent appendicectomy during the COVID-19 pandemic and 35 patients during 2019.Overall 17.39% patients underwent laparoscopic appendicectomy in 2020 while 54.29% in 2019. The negative appendicectomy rate was zero during the pandemic while it was 17.14% in 2019. There was no difference in the median length of hospital stay during the two time periods. There was no significant difference in complication or re-admission rate.
Conclusion:
This study has the lowest reported incidence of negative appendicectomy rate during the pandemic following wider use of pre operative imaging and early senior involvement in decision making. The increased number of complicated appendicitis during the pandemic did not translate to worse clinical outcomes.
