Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 820-829
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.820
COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing: A single-center study
Peng Zhang, Qian Zhang, Hong-Wei Zhao
Peng Zhang, Qian Zhang, Hong-Wei Zhao, Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
Author contributions: Zhang P and Zhang Q contributed equally to this work; Zhang P and Zhang Q designed the research study; Zhang P, Zhang Q and Zhao HW performed the research; Zhang Q and Zhao HW contributed new reagents and analytic tools; Zhang P and Zhang Q analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Beijing Tsinghua Changgung Hospital institutional review board.
Informed consent statement: Waiver of informed consent.
Conflict-of-interest statement: The authors declared that they have no conflicts of interest to this work.
Data sharing statement: The consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Peng Zhang, MD, Attending Doctor, Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing 102218, China. 13911025919@139.com
Received: July 26, 2021
Peer-review started: July 26, 2021
First decision: October 25, 2021
Revised: October 27, 2021
Accepted: December 23, 2021
Article in press: December 23, 2021
Published online: January 21, 2022
Processing time: 173 Days and 10.8 Hours
Abstract
BACKGROUND

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, outcomes and management of many diseases have been affected. Acute appendicitis is a common acute abdomen. The incidence rate is 0.05%-0.5%. Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic. People avoided going to the hospital for fear of being infected. Different countries have different epidemic prevention measures that result in different treatment outcomes. The Chinese government also published some temporary measures in order to prevent the outbreak.

AIM

To explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.

METHODS

Patients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed. Cases were grouped according to admission year. The demographic characteristics, present illnesses, medical history, symptoms and signs, comorbidities, blood test results, imaging data, appendix pathology, and treatment details were compared.

RESULTS

Overall, 74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019, whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020. Fever, thick appendix, nonsurgical management, and uncomplicated appendicitis (simple or supportive appendicitis) were more common in group 2020 (P < 0.05). Among the nonsurgical management cases, the neutrophil percentage, neutrophil-to-lymphocyte ratio, and recurrence rate were higher in group 2020 (P < 0.05). Among surgically managed cases, there were more cases with gastrointestinal symptoms, peritonitis, ascites in the image, and intraoperative adhesion or ascites in group 2020 (P < 0.05). The white blood cell count, time from diagnosis to surgery, surgical time, and intraoperative blood loss were higher in group 2020 (P < 0.05).

CONCLUSION

During the COVID-19 pandemic, patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment. For patients who underwent surgical management, the operation was delayed and more difficult during the pandemic. Nevertheless, the hospital stay and the incidence of postsurgical complications did not change.

Keywords: COVID-19; Acute appendicitis; Case management; Treatment outcome; Antibiotic treatment; Laparoscopic appendectomy

Core Tip: Our paper showed that patients suffering from acute appendicitis in the northern part of Beijing tended to present with severe symptoms and opt for non-surgical treatment during the coronavirus disease 2019 pandemic. For patients who underwent surgical treatment, the operation was delayed and was more difficult during the pandemic. Nevertheless, the hospital stay and the incidence of post-surgical complications did not change. We also found laparoscopic appendectomy was safe for patients followed by Chinese government temporary measures.