Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective

Medientyp: E-Artikel

Titel: Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective

Beteiligte: Forssten, Maximilian Peter; Kaplan, Lewis J.; Tolonen, Matti; Martinez-Casas, Isidro; Cao, Yang; Walsh, Thomas N.; Bass, Gary Alan; Mohseni, Shahin; Ahl Hulme, Rebecka; Biloslavo, Alan; Kurihara, Hayato; Pereira, Jorge; Pourlotfi, Arvid; Ryan, Éanna J.; Louri, Nayef; Nedham, Fatema; Walsh, Thomas Noel; Hashem, Jamal; Corbally, Martin; Farhan, Abeer; Al Hamad, Hamad; Elhennawy, Rawan; AlKooheji, Mariam; AlYusuf, Manar; [...]

Erschienen: Springer Science and Business Media LLC, 2023

Sprache: Englisch

DOI: 10.1007/s00068-022-02149-w

ISSN: 1863-9933; 1863-9941

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Beschreibung: Abstract Introduction The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15 years who underwent appendectomy for appendicitis (November 2020–May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.

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