Department of General Surgery, Monash Health, Melbourne, Victoria, Australia.
School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
ANZ J Surg. 2022 May;92(5):1066-1070. doi: 10.1111/ans.17655. Epub 2022 Apr 16.
The COVID-19 pandemic presents ongoing challenges for healthcare. Stay at Home orders ('lockdowns') and community fears have been suggested to create reluctance to seek healthcare. We aimed to determine whether the rates of perforated appendicitis and negative appendicectomy have been affected by the pandemic, and to analyse the effect of lockdowns on the management of acute appendicitis in Victoria.
We conducted a retrospective audit of emergency appendicectomies performed under adult General Surgery units at Monash Health in Victoria from January 2019 to September 2021, including 242 days of lockdown.
2459 patients were included. Fewer patients had perforated appendicitis during the second lockdown (6.3% versus 10.7% baseline; p = 0.027). The rate of negative appendicectomy was reduced during the first lockdown (4.1% versus 14.9% baseline; p = 0.002) and during intervals between lockdown in 2021 (9.8%; p = 0.010). There was no difference in the rate of perforated appendicitis or negative appendicectomy at other times. Time to surgery and number of appendicectomies performed were also not significantly different. Fewer appendicectomies were performed after hours during lockdowns and in 2021 more generally compared to baseline (p < 0.05).
The lower negative appendicectomy rate during the first lockdown may reflect increased pre-operative imaging or clinical observation for undifferentiated presentations. There was a reduction in perforated appendicitis during the second lockdown, and no significant difference at other times. Contrary to other studies, lockdowns associated with the COVID-19 pandemic may not create a reluctance to seek healthcare in all regions.
COVID-19 大流行给医疗保健带来了持续的挑战。有研究表明，居家令（“封锁”）和社区的恐惧心理可能导致人们不愿意寻求医疗服务。我们旨在确定大流行是否影响了穿孔性阑尾炎和阴性阑尾切除术的发生率，并分析封锁对维多利亚州急性阑尾炎管理的影响。
我们对维多利亚州蒙纳什健康成人普通外科病房进行的急诊阑尾切除术进行了回顾性审计，包括 242 天的封锁期，时间为 2019 年 1 月至 2021 年 9 月。
共纳入 2459 例患者。第二次封锁期间穿孔性阑尾炎的患者比例较低（6.3%比基线的 10.7%；p=0.027）。第一次封锁期间（4.1%比基线的 14.9%；p=0.002）和 2021 年封锁间隔期间（9.8%；p=0.010）阴性阑尾切除术的发生率降低。其他时间穿孔性阑尾炎或阴性阑尾切除术的发生率没有差异。手术时间和阑尾切除术数量也没有显著差异。封锁期间和 2021 年总体上，下班后进行的阑尾切除术较少（p<0.05）。
第一次封锁期间阴性阑尾切除术率较低，可能反映出对未分化表现进行了更多的术前影像学检查或临床观察。第二次封锁期间穿孔性阑尾炎减少，其他时间没有显著差异。与其他研究不同，与 COVID-19 大流行相关的封锁在所有地区可能不会导致不愿意寻求医疗服务。
