Non-operative Management for Acute Appendicitis During the COVID-19 Pandemic Does Not Increase the Rate of Complications
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RESEARCH COMMUNICATION
Non-operative Management for Acute Appendicitis During the COVID-19 Pandemic Does Not Increase the Rate of Complications Vishal K. Patel 1 & Kenny Ye 2 & Haejin In 3 & Meir H. Scheinfeld 4 Received: 8 August 2020 / Accepted: 17 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords COVID-19 . COVID . Corona virus . Appendicitis . Appendectomy . Complications
Introduction The COVID-19 pandemic has placed unprecedented stress on the healthcare system [1]. In response to government mandates and society recommendations, even emergency surgical procedures such as appendectomies have been curtailed, with non-surgical management used whenever possible [2, 3]. The goal of our study was to determine whether changes in acute appendicitis management have altered the frequency of complications in these patients.
Methods IRB approval was obtained for this retrospective cohort study performed at an urban tertiary care medical center during the COVID-19 pandemic which in our area extended from March 15 through May 31, 2020. The equivalent 77-day
period from 2019 was used for comparison. The imaging database was queried for all reports with the word “appendicitis.” Imaging, operative notes, and pathology reports were used to classify cases as perforated or non-perforated appendicitis [4]. The EMR was reviewed for each case to extract the duration of symptoms prior to presentation, management, length of hospital stay (LOS), and complications within 45 days of presentation. Complications were divided into minor (Clavien-Dindo I and II) and major (Clavien-Dindo > II). Fisher exact tests were used to compare perforation rate, sex, baseline comorbidities, and non-operative treatment between years. Two sample t tests were used to compare age. Linear regression models were used to compare the duration of symptoms and LOS with perforation as a covariate. A Mantel-Haenszel test was used to compare complications conditional on perforation. Statistical analyses were performed using R-software.
This work has not been presented at a scientific meeting. Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s11605-02004844-8. * Meir H. Scheinfeld [email protected]
2
Department of Epidemiology & Population Health, Department of Systems & Computational Biology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Block BD #310, Bronx, NY 10461, USA
3
Montefiore Medical Center, Department of Surgery, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Block BD #112, Bronx, NY 10461, USA
4
Montefiore Medical Center, Department of Radiology, Division of Emergency Radiology, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY 10467, USA
Vishal K. Patel [email protected] Kenny Ye [email protected] Haejin In [email protected] 1
Montefiore Medical Center, Department of Radiology, Albert Einstein College of Medicine, 111 East 210 Street,
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