B Ielpo1, M Podda2, G Pellino3,4, F Pata5,6, R Caruso7, G Gravante8, S Di Saverio9. 1. Department of Surgery, Hepatopancreatobiliary Unit, University Hospital Leon, Leon, Spain. 2. Department of General and Emergency Surgery, Cagliari University Hospital, Azienda Ospedaliero-Universitaria, Cagliari, Italy. 3. Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain. 4. Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy. 5. General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy. 6. Department of General Surgery, La Sapienza University, Rome, Italy. 7. Hospital Universitario HM Sanchinarro, Madrid, Spain. 8. Department of General Surgery, Ospedale 'Francesco Ferrari', Casarano, Italy. 9. Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Varese, Italy.
Abstract
BACKGROUND: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. METHODS: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. RESULTS: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P < 0·001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. CONCLUSION: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2.
BACKGROUND: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. METHODS: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. RESULTS: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19·8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6·6 and 2·4 per cent respectively before, but 23·7 and 5·3 per cent, during the pandemic (both P < 0·001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. CONCLUSION: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2.
Authors: David C Chang; Aki Shiozawa; Louis L Nguyen; Kristin L Chrouser; Bruce A Perler; Julie A Freischlag; Paul M Colombani; Fizan Abdullah Journal: J Am Coll Surg Date: 2010-11-30 Impact factor: 6.113
Authors: Mollie Ferris; Samuel Quan; Belle S Kaplan; Natalie Molodecky; Chad G Ball; Greg W Chernoff; Nij Bhala; Subrata Ghosh; Elijah Dixon; Siew Ng; Gilaad G Kaplan Journal: Ann Surg Date: 2017-08 Impact factor: 12.969
Authors: Mauro Podda; Chiara Gerardi; Nicola Cillara; Nicola Fearnhead; Carlos Augusto Gomes; Arianna Birindelli; Andrea Mulliri; Richard Justin Davies; Salomone Di Saverio Journal: Ann Surg Date: 2019-12 Impact factor: 12.969
Authors: Thomas Jaschinski; Christoph G Mosch; Michaela Eikermann; Edmund Am Neugebauer; Stefan Sauerland Journal: Cochrane Database Syst Rev Date: 2018-11-28