Open AccessEVALUATION OF APPENDICITIS MANAGEMENT DURING EARLY COVID-19 PANDEMIC AND LITERATURE REVIEW
Author(s) -
Richard Lim,
Ee Peng Lee,
Henry Chor Lip Tan,
Jih Huei Tan,
Sze Lyn Pang,
Kuok Zhen Lee,
Visagan Diya Das,
Tuan Nur’ Azmah Tuan Mat
Publication year - 2020
Publication title -
journal of health and translational medicine
Language(s) - English
Resource type - Journals
eISSN - 2289-392X
pISSN - 1823-7339
DOI - 10.22452/jummec.sp2020no1.5
Subject(s) - medicine , asymptomatic , pandemic , appendicitis , covid-19 , incidence (geometry) , medical record , observational study , retrospective cohort study , acute appendicitis , general surgery , emergency medicine , surgery , disease , physics , infectious disease (medical specialty) , optics
Purpose: Numerous guidelines have been proposed in managing surgical emergencies during COVID-19 pandemic. Literature on the implications of these adjustments during this pandemic remained limited. This review aims to examine the implications of these critical adjustments with focus on appendicitis management. Method: This is a single-centre retrospective observational study in a Malaysian tertiary state surgical centre and review of recent guidelines and literature. Patients with appendicitis from March to May 2020 were included and medical records were reviewed and analysed. Results: Of the 173 appendicitis patients, 117 (67.6%) were operated and 56 (32.4%) were conservatively treated. Those screened for SARS-CoV-2 pre-operatively showed longer wait for operation (3.0 vs 2.0 days, p=0.001) and a longer hospital stay (4.5 vs 4.0 days, p=0.005). One-third of patients screened (36.6%) were expedited for surgery on clinical suspicion of complicated appendicitis and 42.1% progressed from acute to complicated appendicitis while waiting for screening result. All patients screened were COVID-19 negative. Delay due to SARS-CoV-2 screening did not result in worse outcome for appendicitis patients. Conclusion: With the increase in incidence and rise of COVID-19 cases, routine screening by questionnaire, physical examination and naso-oropharyngeal swab may be considered to detect asymptomatic carrier, especially in regions with high infection. Regular reassessment with low threshold to expedite the surgery is necessary, to ensure satisfactory surgical outcome.