Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura, 35516, Egypt.
Department of Surgery, Soba University Hospital, Khartoum, Sudan.
J Gastrointest Surg. 2021 Jul;25(7):1905-1915. doi: 10.1007/s11605-021-04988-1. Epub 2021 Mar 26.
Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19.
This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess.
Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8-70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p < 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4-23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4-7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM.
NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates.
在 COVID-19 大流行之前，已经有几项研究评估了急性阑尾炎的非手术治疗（NOM）。本系统评价旨在评估 COVID-19 背景下急性阑尾炎 NOM 的应用程度、疗效和安全性。
这是一项符合 PRISMA 标准的文献系统评价。电子数据库和 Google Scholar 被用来查询在 COVID-19 期间应用急性阑尾炎 NOM 的研究。主要观察指标是与大流行前相比，大流行期间 NOM 的应用率、NOM 失败率和并发症率。失败定义为在 NOM 期间需要进行阑尾切除术，并发症包括阑尾脓肿或脓肿的形成。
纳入了 14 项研究（2140 名患者）。男女比例为 1.44:1，中位年龄为 34 岁。959 名（44.8%）患者尝试了 NOM。NOM 的应用率加权平均值为 50.1%（95%CI：29.8-70.5%）。与 COVID-19 前相比，大流行期间 NOM 的应用明显更有可能（OR=6.7，p<0.001）。NOM 失败的加权平均值为 16.4%（95%CI：9.4-23.4）。NOM 失败更可能发生在儿童和患有复杂性阑尾炎的患者中。NOM 后并发症的加权平均值为 4.5%（95%CI：1.4-7.7）。NOM 的并发症发生率明显低于阑尾切除术（OR=0.36，p=0.03）。NOM 应用后无死亡病例。
在 COVID-19 背景下，急性阑尾炎的 NOM 可能是一种安全、短期的手术替代方案，其失败率和并发症率可接受较低。
