Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital.
Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital.
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DOI：
10.1186/s12893-021-01231-1
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发表时间：
2021-05-12
期刊：
影响因子：
1.9
通讯作者：
Bethune RM
中科院分区：
文献类型：
--
作者：
Pringle HCM;Donigiewicz U;Bennett MR;Walker E;Fowler GE;Narang S;Ball S;Bethune RM
COVID-19大流行极大地影响了医疗保健的提供。根据英国皇家学院的建议，急性阑尾炎（AA）的治疗方法发生了变化，在寻求手术治疗（OM）时，更多地考虑非手术治疗（NOM）或开放阑尾切除术。我们描述了我们在这些患者的表现、管理和结果方面的经验，以便为未来的病毒大流行提供护理信息。这项回顾性队列研究将2019年3月至7月期间被诊断为AA的患者与2020年3月至7月大流行期间的患者进行了比较。对医疗记录进行审查，以获得人口统计学、炎症标志物、影像学、严重程度、管理、组织学、住院时间（LOS）和90天结果。2019年和2020年的队列分别有149名和125名患者。2019年有14例（9.4%）患者有NOM，而2020年有31例（24.8%）（p = 0.001）。在2019年的手术管理（OM）组中，125例（92.6%）患者接受了腹腔镜阑尾切除术，而2020年为65例（69.1%）。2019年有59名患者（39.6%）接受了CT检查，而2020年为70名（56%）。2019年的中位生存期为4天，2020年为3天（p = 0.03）。每年有2例患者接受NOM治疗失败（2019年为14.3%，2020年为6.5%）。2019年接受OM治疗失败3例（2.2%）。在接受COVID-19检测的95名患者中，除一人外，其余均呈阴性。在COVID-19大流行期间，没有观察到AA严重程度的增加，患者的LOS较短，更有可能进行影像学检查。NOM按比例增加，但没有观察到结果的变化。在线版本包含补充材料，可在10.1186/s12893-021-01231-1获得。
The COVID-19 pandemic dramatically influenced the delivery of healthcare. In line with the UK Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy when operative management (OM) was sought. We describe our experience of the presentation, management and outcomes for these patients to inform care for future viral pandemics. This retrospective, cohort study compared patients diagnosed with AA between March and July 2019 with those during the pandemic period of March to July 2020. Medical records were reviewed to obtain demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS) and 90-day outcomes. There were 149 and 125 patients in the 2019 and 2020 cohorts respectively. 14 patients (9.4%) had NOM in 2019 versus 31 (24.8%) in 2020 (p = 0.001). In the 2019 operative management (OM) group 125 patients (92.6%) had laparoscopic appendicectomy versus 65 (69.1%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days in 2019 and 3 days in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who received OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one tested negative. During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes. The online version contains supplementary material available at 10.1186/s12893-021-01231-1.
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