Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
PLoS One. 2022 Nov 3;17(11):e0270241. doi: 10.1371/journal.pone.0270241. eCollection 2022.
Acute appendicitis is one of the most common surgical emergencies; however, optimal diagnosis and treatment of acute appendicitis remains challenging. We used the coronavirus disease 2019 (COVID-19) lockdown policy as a natural experiment to explore potential overdiagnosis and overtreatment of acute appendicitis in Thailand. The aim of this study was to estimate the potential overdiagnosis and overtreatment of acute appendicitis in Thailand by examining service utilization before, during, and after the COVID-19 lockdown policy.
A secondary data analysis of patients admitted with acute appendicitis under the Universal Coverage Scheme (UCS) in Thailand over a 6-year period between 2016 and 2021 was conducted. The trend of acute appendicitis was plotted using a 14-day rolling average of daily cases. Patient characteristics, clinical management, and outcomes were descriptively presented and compared among three study periods, namely pre-pandemic, lockdown, and post-lockdown.
The number of overall acute appendicitis cases decreased from 25,407 during pre-pandemic to 22,006 during lockdown (13.4% reduction) and 21,245 during post-lockdown (16.4% reduction). This reduction was mostly due to a lower incidence of uncomplicated acute appendicitis, whereas cases of generalized peritonitis were scarcely affected by the pandemic. There was an increasing trend towards the usage of diagnostic computerized tomography for acute appendicitis but no significant difference in treatment modalities and complication rates.
The stable rates of generalized peritonitis and complications during the COVID-19 lockdown, despite fewer admissions overall, suggest that there may have been overdiagnosis and overtreatment of acute appendicitis in Thailand. Policy makers could use these findings to improve clinical practice for acute appendicitis in Thailand and support the efficient utilization of surgical services in the future, especially during pandemics.
急性阑尾炎是最常见的外科急症之一；然而，急性阑尾炎的最佳诊断和治疗仍然具有挑战性。我们利用 2019 年冠状病毒病（COVID-19）封锁政策作为一项自然实验，来探讨泰国急性阑尾炎的潜在过度诊断和过度治疗。本研究的目的是通过检查 COVID-19 封锁政策前后的服务利用情况，来估计泰国急性阑尾炎的潜在过度诊断和过度治疗。
对泰国全民医疗保险计划（UCS）下 2016 年至 2021 年期间 6 年内因急性阑尾炎住院的患者进行二次数据分析。使用 14 天滚动平均每日病例数绘制急性阑尾炎趋势图。描述性呈现患者特征、临床管理和结局，并在三个研究期间（即大流行前、封锁期间和封锁后）进行比较。
总的急性阑尾炎病例数从大流行前的 25407 例减少到封锁期间的 22006 例（减少 13.4%）和封锁后 21245 例（减少 16.4%）。这种减少主要是由于单纯性急性阑尾炎的发病率降低，而弥漫性腹膜炎的病例几乎不受大流行的影响。急性阑尾炎诊断用计算机断层扫描的使用呈上升趋势，但治疗方式和并发症发生率没有显著差异。
尽管总体住院人数减少，但 COVID-19 封锁期间弥漫性腹膜炎和并发症的发生率保持稳定，这表明泰国可能存在急性阑尾炎的过度诊断和过度治疗。政策制定者可以利用这些发现来改善泰国急性阑尾炎的临床实践，并在未来（尤其是大流行期间）支持外科服务的有效利用。
