Impact of COVID-19 on presentation, management, and outcomes of acute care surgery for gallbladder disease and acute appendicitis

Table 1 Demographic characteristics of patients, stratified by cohort and time period

	Appendicitis					Gallbladder disease
	March–June 2019		March–June 2020		P value	March–June 2019		March–June 2020		P value
	n	(%)	n	(%)		n	(%)	n	(%)
Demographics	182	50	179	50		152	49	161	51
Age, median (IQR)	24.9	13.8–47.2	32.2	15.1–48.9	0.33	46.7	32.6–65.3	48.8	35.4–61.4	0.99
Gender, n (%)					0.57					0.33
Female	77	42	82	46		97	64	93	58
Male	105	58	97	54		55	36	68	42
Race, n (%)					0.35					0.98
White	96	53	79	44		58	32	58	32
Black or African American	1	1	3	2		7	4	8	4
Asian	35	19	40	22		29	16	31	17
Other	50	27	57	32		58	32	64	36
Interpreter needed, n (%)	25	14	24	13	> 0.99	23	13	28	16	0.68
Spanish	21	84	18	75	0.50	20	87	24	86	0.78
BMI, median (IQR)	24.2	20.2–29.8	23.1	19.9–27.5	0.13	28.8	25.8–32.5	29.5	24.5–33.9	0.73
Charlson Comorbidity score					0.35					0.22
None: CCI score 0, n (%)	136	75	133	74		80	53	69	43
Mild: CCI score 1-2, n (%)	31	17	24	13		33	22	46	29
Moderate: CCI score 3-4, n (%)	12	7	14	8		21	14	26	16
Severe: CCI ≥ 5, n (%)	3	2	8	4		14	9	19	12

CCI: Comprehensive complication index; BMI: Body mass index.

Table 2 Gallbladder disease presentation, management, and operative findings

	Gallbladder disease
	March–June 2019		March–June 2020		P value
	152		161
Diagnosis, n (%)					0.01
Symptomatic cholelithiasis	99	65%	81	50%
Acute cholecystitis	53	35%	80	50%
Tokyo criteria, mean (STD)	1.17	0.437	1.39	0.562	0.02
Symptom duration prior to ED (d), mean (STD)	2.9	5.8	4.2	12.7	0.21
ED length of stay (h), median (IQR)	5	(3.5–7)	5	(4–7)	0.55
Disposition from ED					0.02
Discharged, n (%)	52	34%	41	25%
Discharged with urgent follow up, n (%)	17	11%	15	9%
Admitted, n (%)	76	50%	104	65%
Other, n (%)	7	5%	1	1%
Time from presentation to OR (h), median (IQR)	18	(11–28.2)	19	(13–27.5)	0.42
Pre-op ERCP required, n (%)	22	14%	18	11%	0.40
Antibiotics during admission, n (%)	61	80%	98	94%	0.10
Underwent surgical procedure, n (%)	61	40%	83	52%	0.06
Symptomatic cholelithiasis	16	16%	22	27%	0.098
Acute cholecystitis	45	87%	61	76%	0.12
Operations performed, n (%)					0.75
Laparoscopic cholecystectomy	55	90%	75	90%
Laparoscopic converted to open cholecystectomy	2	3%	1	1%
Percutaneous cholecystostomy	4	7%	7	8%
Post-op diagnosis, n (%)					0.23
Acute cholecystitis only	38	62%	43	52%
Acute cholecystitis with gallbladder mucocele (Hydrops)	1	2%	2	3%
Acute gangrenous cholecystitis	6	10%	14	17%
Acute hemorrhagic cholecystitis	1	2%	0	0%
Symptomatic cholelithiasis	6	10%	11	13%
Chronic cholecystitis	1	2%	8	10%
Other	7	12%	6	7%
Choledocholithiasis present, n (%)–Biliary colic subgroup	24	16%	28	17%	0.92
Drains left in place post op, n (%)	8	13%	15	18%	0.39
Patients with additional procedures, n (%)	8	13%	7	8%	0.40
Drain placement	1	6%	0	0%
PICC line	0	0%	1	7%
Lysis of adhesions	0	0%	2	13%
Intra-op cholangiogram	1	6%	1	7%

ED: Emergency departments; ERCP: Endoscopic retrograde cholangiopancreatography; OR: Odds ratios; PICC: Peripherally inserted central catheters.

Table 3 Gallbladder disease postoperative course and complications

	Gallbladder disease
	March–June 2019		March–June 2020		P value
	152		161
Length of stay for surgically managed patients (d), median (IQR)	3	(2–4)	2	(1–3)	0.3
Discharged on antibiotics, n (%)	21	14%	29	18%	0.39
Inpatient complications, n (%)	10	16%	11	13%	0.62
Sepsis	0	0%	4	5%
Transaminitis	1	2%	1	1%
Death	0	0%	1	1%	> 0.99
Representation within 30 d, n (%)	16	11%	20	12%	0.71
Postoperative intra-abdominal abscess	0	0%	1	1%
Cholecystitis	3	2%	4	2%
Cholelithiasis/Choledocholithiasis	1	1%	5	3%

Table 4 Appendicitis presentation, management, and operative findings

	Appendicitis
	March–June 2019		March–June 2020		P value
	182		179
Alvarado score, mean (SD)	6.53	1.82	6.50	1.89	0.63
Ruptured appendix, n (%) at diagnosis	29	16%	36	20%	0.02
Ruptured appendix, n (%) post op	43	23%	41	23%	0.68
Symptom duration prior to ED (d), mean (SD)	2.72	7.23	2.19	3.12	0.36
ED severity score, mean (SD)	2.87	0.33	2.37	0.49	< 0.0001
Resucitation, n (%))	0	0%	0	0%
Emergent, n (%)	23	13%	112	63%
Non-emergent, n (%)	159	87%	67	37%
ED length of stay (h), median (IQR)	5.00	3.5–6.6	6.00	4–7	0.51
Disposition from ED					0.57
Discharged, n (%)	3	2%	3	2%
Discharged with urgent follow up, n (%)	0	0%	1	1%
Admitted, n (%)	174	96%	173	97%
Underwent surgical procedure, n (%)	150	82%	156	87%	0.47
Laparoscopic appendectomy	145	97%	149	96%
Laparoscopic converted to open appendectomy	2	1%	1	1%
Right hemicolectomy	2	1%	0	0%
Percutaneous abscess drain (IR)	1	1%	6	4%
Post-op diagnosis, n (%)
Ruptured appendix	43	29%	41	26%	0.68
Appendix not ruptured	106	71%	116	74%
Time from presentation to OR (h), median (IQR)	11.2	6–17	11.0	6–17	0.38
Drains left in place post op, n (%)	6	4%	11	7%	0.07
Patients with additional procedures, n (%)	17	11%	11	7%	0.27
Draining of abscess	7	41%	2	18%
Bowel resection	2	12%	0	0%
Drain placement	3	18%	1	9%
PICC line	1	6%	2	18%
NGT placement	0	0%	2	18%

ED: Emergency departments; OR: Odds ratios; PICC: Peripherally inserted central catheters; IR: Immunoreactive; NGT: Nasogastric tube.

Table 5 Appendicitis postoperative course and complications

	Appendicitis
	March–June 2019		March–June 2020		P value
	182		179
Length of stay (d), median (IQR)	2.00	2–3	2.00	2–3	> 0.99
Discharged on antibiotics, n (%)	35	19%	52	29%	0.04
Patients with Inpatient complications, n (%)	5	3%	10	6%	0.32
Sepsis	0	0%	2	18%
Post op ileus	3	27%	2	18%
Abscess	3	27%	0	0%
Representation within 30 d, n (%)	8	4%	23	13%	< 0.01