From the Department of Surgery (E.A.G., M.P.R., H.M.J., R.P., J.J.D., P.C.K., M.D.R.), University of South Florida Morsani College of Medicine, Tampa, Florida; SporeData Inc. (R.P.), Durham, North Carolina; and Department of Surgical Oncology, Moffitt Cancer Center (M.D.R.), Tampa, Florida.
J Trauma Acute Care Surg. 2024 Mar 1;96(3):418-428. doi: 10.1097/TA.0000000000004205. Epub 2023 Dec 12.
Previous studies on nonoperative management (NOM) of acute appendicitis (AA) indicated comparable outcomes to surgery, but the effect of COVID-19 infection on appendicitis outcomes remains unknown. Thus, we evaluate appendicitis outcomes during the COVID-19 pandemic to determine the effect of COVID-19 infection status and treatment modality. We hypothesized that active COVID-19 patients would have worse outcomes than COVID-negative patients, but that outcomes would not differ between recovered COVID-19 and COVID-negative patients. Moreover, we hypothesized that outcomes would not differ between nonoperative and operative management groups, regardless of COVID-19 status.
We queried the National COVID Cohort Collaborative from 2020 to 2023 to identify adults with AA who underwent operative or NOM. COVID-19 status was denoted as follows: COVID-negative, COVID-active, or COVID-recovered. Intention to treat was used for NOM. Propensity score-balanced analysis was performed to compare outcomes within COVID groups, as well as within treatment modalities.
A total of 37,868 patients were included: 34,866 COVID-negative, 2,540 COVID-active, and 460 COVID-recovered. COVID-active and recovered less often underwent operative management. Unadjusted, there was no difference in mortality between COVID groups for operative management. There was no difference in rate of failure of NOM between COVID groups. Adjusted analysis indicated, compared with operative, NOM carried higher odds of mortality and readmission for COVID-negative and COVID-active patients.
This study demonstrates higher odds of mortality among NOM of appendicitis and near equivalent outcomes for operative management regardless of COVID-19 status. We conclude that NOM of appendicitis is associated with worse outcomes for COVID-active and COVID-negative patients. In addition, we conclude that a positive COVID test or recent COVID-19 illness alone should not preclude a patient from appendectomy for AA. Surgeon clinical judgment of a patient's physiology and surgical risk should, of course, inform the decision to proceed to the operating room.
Therapeutic/Care Management; Level III.
先前关于急性阑尾炎（AA）非手术治疗（NOM）的研究表明，其与手术治疗的结果相当，但 COVID-19 感染对阑尾炎结局的影响尚不清楚。因此，我们评估了 COVID-19 大流行期间阑尾炎的结局，以确定 COVID-19 感染状况和治疗方式的影响。我们假设，与 COVID-19 阴性患者相比，活跃的 COVID-19 患者的结局更差，但 COVID-19 康复患者与 COVID-19 阴性患者之间的结局没有差异。此外，我们假设，无论 COVID-19 状态如何，非手术治疗和手术治疗组之间的结局不会有差异。
我们从 2020 年至 2023 年查询了国家 COVID 队列协作研究，以确定接受手术或 NOM 的 AA 成年患者。COVID-19 状态表示为：COVID-19 阴性、COVID-19 活跃和 COVID-19 康复。NOM 采用意向治疗。在 COVID 组内以及在治疗方式内，使用倾向评分匹配分析来比较结局。
共纳入 37868 例患者：34866 例 COVID-19 阴性，2540 例 COVID-19 活跃，460 例 COVID-19 康复。COVID-19 活跃和康复患者较少接受手术治疗。未经调整，手术治疗时，COVID 各组之间的死亡率无差异。COVID 各组之间 NOM 失败率无差异。调整分析表明，与手术治疗相比，COVID-19 阴性和 COVID-19 活跃患者的 NOM 死亡率和再入院率更高。
本研究表明，阑尾炎 NOM 的死亡率更高，而无论 COVID-19 状态如何，手术治疗的结局相当。我们得出结论，对于 COVID-19 活跃和 COVID-19 阴性患者，NOM 阑尾炎与更差的结局相关。此外，我们得出结论，阳性 COVID 检测或近期 COVID-19 疾病本身不应排除患者接受 AA 阑尾切除术。当然，外科医生对患者生理和手术风险的临床判断应该告知是否进入手术室的决策。
治疗/护理管理；III 级。
