Division of Digestive Diseases, Addenbrooke's Hospital, Cambridge, UK.
Division of Digestive Diseases, Addenbrooke's Hospital, Cambridge, UK.
Int J Surg. 2021 Feb;86:32-37. doi: 10.1016/j.ijsu.2020.12.009. Epub 2021 Jan 16.
During the Covid-19 pandemic, non-operative management for acute appendicitis (AA) was implemented in the UK. The aim of this study was to determine the efficacy and outcomes of conservative versus surgical management of AA during the pandemic.
MATERIALS & METHODS: We conducted an observational study in a tertiary referral centre. Data was collected from all patients (≥16 years) with a diagnosis of AA between November 1, 2019 to March 10, 2020 (pre-COVID period) and March 10, 2020 to July 5, 2020 (COVID period).
A total of 116 patients in the pre-COVID period were included versus 91 in the COVID period. 43.1% (n = 50) of patients pre-COVID were classified as ASA 2 compared to 26.4% (n = 24) during the COVID period (p-value = 0.042). 72.5% (n = 66) of the patients during the COVID period scored as high risk using the Alvarado score compared to 24.1% (n = 28) in the pre-COVID period (p-value<0.001). We observed a significant increase in radiological evaluation, 69.8% versus 87.5% of patients had a CT in the pre-COVID and COVID periods respectively (p-value = 0.008). 94.9% of patients were managed operatively in the pre-COVID period compared to 60.4% in the COVID period (p-value<0.001). We observed more open appendicectomies (37.3% versus 0.9%; p-value<0.001) during the COVID period compared to the pre-COVID period. More abscess formation and free fluid were found intraoperatively in the COVID period (p-value = 0.021 and 0.023 respectively). Re-attendance rate due to appendicitis-related issues was significantly higher in the COVID period (p = 0.027).
Radiological diagnosis of AA was more frequent during the COVID period. More conservative management for AA was employed during the COVID-19 pandemic, and for those managed operatively an open approach was preferred. Intra-operative findings were suggestive of delayed presentation during the COVID period without this affecting the length of hospital stay.
在新冠疫情期间，英国对急性阑尾炎（AA）采用了非手术治疗。本研究旨在确定在疫情期间保守治疗与手术治疗 AA 的疗效和结果。
我们在一家三级转诊中心进行了一项观察性研究。数据收集自 2019 年 11 月 1 日至 2020 年 3 月 10 日（新冠前）和 2020 年 3 月 10 日至 2020 年 7 月 5 日（新冠期间）期间所有诊断为 AA 的患者（≥16 岁）。
新冠前共纳入 116 例患者，新冠期间纳入 91 例。新冠前有 43.1%（n=50）患者为 ASA 2 级，而新冠期间为 26.4%（n=24）（p 值=0.042）。新冠期间，72.5%（n=66）的患者使用 Alvarado 评分被评估为高风险，而新冠前为 24.1%（n=28）（p 值<0.001）。我们观察到影像学评估显著增加，新冠前和新冠期间分别有 69.8%和 87.5%的患者进行了 CT 检查（p 值=0.008）。新冠前有 94.9%的患者接受了手术治疗，而新冠期间为 60.4%（p 值<0.001）。与新冠前相比，新冠期间行开腹阑尾切除术的患者更多（37.3%与 0.9%；p 值<0.001）。新冠期间术中发现脓肿形成和游离液更多（p 值分别为 0.021 和 0.023）。因阑尾炎相关问题再次就诊的比例在新冠期间显著更高（p=0.027）。
新冠疫情期间 AA 的放射学诊断更为频繁。在新冠疫情期间，对 AA 采用了更保守的治疗方法，对于接受手术治疗的患者，更倾向于采用开腹手术。术中发现表明新冠期间就诊时间延迟，但这并未影响住院时间。
