Neufeld Miriam Y, Bauerle Wayne, Eriksson Evert, Azar Faris K, Evans Heather L, Johnson Meredith, Lawless Ryan A, Lottenberg Lawrence, Sanchez Sabrina E, Simianu Vlad V, Thomas Christopher S, Drake F Thurston
Department of Surgery, Boston Medical Center/Boston University School of Medicine, MA.
Department of Surgery, Medical University of South Carolina, Charleston, SC.
Surgery. 2021 Apr;169(4):808-815. doi: 10.1016/j.surg.2020.10.035. Epub 2020 Dec 4.
The coronavirus disease 2019 pandemic restricted movement of individuals and altered provision of health care, abruptly transforming health care-use behaviors. It serves as a natural experiment to explore changes in presentations for surgical diseases including acute appendicitis. The objective was to determine if the pandemic was associated with changes in incidence of acute appendicitis compared to a historical control and to determine if there were associated changes in disease severity.
The study is a retrospective, multicenter cohort study of adults (N = 956) presenting with appendicitis in nonpandemic versus pandemic time periods (December 1, 2019-March 10, 2020 versus March 11, 2020-May 16, 2020). Corresponding time periods in 2018 and 2019 composed the historical control. Primary outcome was mean biweekly counts of all appendicitis presentations, then stratified by complicated (n = 209) and uncomplicated (n = 747) disease. Trends in presentations were compared using difference-in-differences methodology. Changes in odds of presenting with complicated disease were assessed via clustered multivariable logistic regression.
There was a 29% decrease in mean biweekly appendicitis presentations from 5.4 to 3.8 (rate ratio = 0.71 [0.51, 0.98]) after the pandemic declaration, with a significant difference in differences compared with historical control (P = .003). Stratified by severity, the decrease was significant for uncomplicated appendicitis (rate ratio = 0.65 [95% confidence interval 0.47-0.91]) when compared with historical control (P = .03) but not for complicated appendicitis (rate ratio = 0.89 [95% confidence interval 0.52-1.52]); (P = .49). The odds of presenting with complicated disease did not change (adjusted odds ratio 1.36 [95% confidence interval 0.83-2.25]).
The pandemic was associated with decreased incidence of uncomplicated appendicitis without an accompanying increase in complicated disease. Changes in individual health care-use behaviors may underlie these differences, suggesting that some cases of uncomplicated appendicitis may resolve without progression to complicated disease.
2019年冠状病毒病大流行限制了个人行动，改变了医疗保健的提供方式，突然改变了医疗保健使用行为。它可作为一项自然实验，用于探索包括急性阑尾炎在内的外科疾病就诊情况的变化。目的是确定与历史对照相比，大流行是否与急性阑尾炎发病率的变化相关，并确定疾病严重程度是否存在相关变化。
本研究是一项回顾性、多中心队列研究，研究对象为在非大流行时期与大流行时期（2019年12月1日至2020年3月10日与2020年3月11日至2020年5月16日）出现阑尾炎的成年人（N = 956）。2018年和2019年的相应时间段构成历史对照。主要结局是所有阑尾炎就诊的平均每两周计数，然后按复杂型（n = 209）和非复杂型（n = 747）疾病进行分层。使用差异-in-差异方法比较就诊趋势。通过聚类多变量逻辑回归评估出现复杂疾病的几率变化。
大流行声明发布后，平均每两周阑尾炎就诊次数从5.4降至3.8，下降了29%（率比 = 0.71 [0.51, 0.98]），与历史对照相比，差异有统计学意义（P = .003）。按严重程度分层，与历史对照相比，非复杂型阑尾炎的下降有统计学意义（率比 = 0.65 [95%置信区间0.47 - 0.91]）（P = .03），但复杂型阑尾炎无统计学意义（率比 = 0.89 [95%置信区间0.52 - 1.52]）；（P = .49）。出现复杂疾病的几率没有变化（调整后的优势比1.36 [95%置信区间0.83 - 2.25]）。
大流行与非复杂型阑尾炎发病率降低相关，且未伴随复杂疾病增加。个体医疗保健使用行为的变化可能是这些差异的原因，这表明一些非复杂型阑尾炎病例可能无需进展为复杂疾病即可自行缓解。
