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

Forssten, Maximilian Peter, Kaplan, Lewis J, Tolonen, Matti, Martinez-Casas, Isidro, Cao, Yang, Walsh, Thomas N, Bass, Gary Alan, Mohseni, Shahin and ESTES SnapAppy Group, (2023) Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 49 (1). pp. 57-67.

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Official URL: http://dx.doi.org/10.1007/s00068-022-02149-w

Abstract

<h4>Introduction</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.

Item Type:	Article
Uncontrolled Keywords:	ESTES SnapAppy Group
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences > School of Medicine
Depositing User:	Symplectic Admin
Date Deposited:	06 Mar 2024 11:19
Last Modified:	06 Mar 2024 11:20
DOI:	10.1007/s00068-022-02149-w
Open Access URL:	https://doi.org/10.1007/s00068-022-02149-w
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3179195