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Objective: The pandemic has affected the entire world. Even though most elective surgeries have been canceled, emergency cases pose a significant concern when the hospital resources are used for patients with COVID. Notably, surgery is the standard treatment for acute appendicitis; however, some studies have analyzed the use of antibiotics in selected cases. Our study aimed to analyze a surgeon’s preferences in treating acute appendicitis during the COVID-19 pandemic.
Material and Method: An online survey was conducted for surgeons via the social media platform. 102 surgeons participated in the survey.. The survey was designed for consultant general surgeons. The survey queried regarding the surgeons’ work hospitals, pandemic status, and treatment strategy before and after the pandemic. Answers to the survey questions were analyzed using descriptive statistics.
Results: 31% of surgeons reported they had changed the treatment strategy for acute appendicitis during the pandemic. 7% of surgeons stated that patients who received antibiotics had to undergo surgery owing to unresponsiveness to the therapy. Two percent of surgeons stated that patients on antibiotherapy developed early complications. Moreover, 29% of surgeons stated that they might change the treatment strategy in selected cases after the COVID-19 pandemic, and only 13% of surgeons may continue to prescribe antibiotics for uncomplicated cases.
Conclusion: Most surgeons did not change the treatment strategy for acute uncomplicated appendicitis during the COVID-19 pandemic. Even though recent guidelines and studies have revealed promising results for antibiotherapy in uncomplicated appendicitis cases, surgery seems to be regarded as the primary treatment strategy.
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Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020 Apr 15;15(1):27. doi: 10.1186/s13017-020-00306-3. PMID: 32295644; PMCID: PMC7386163.
Collard M, Lakkis Z, Loriau J, Mege D, Sabbagh C, Lefevre JH, et al. Crise sanitaire liée au COVID-19 : modalités du traitement de l’appendicite aiguë non compliquée de l’adulte par antibiothérapie seule comme alternative à l’appendicectomie [Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis]. J Chir Visc. 2020 Jun;157(3):S33-S43. French. doi: 10.1016/j.jchirv.2020.04.014. Epub 2020 Apr 30. PMID: 32355509; PMCID: PMC7190476.
CODA Collaborative, Flum DR, Davidson GH, Monsell SE, Shapiro NI, Odom SR, Sanchez SE, et al. A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis. N Engl J Med. 2020 Nov 12;383(20):1907-1919. doi: 10.1056/NEJMoa2014320. Epub 2020 Oct 5. PMID: 33017106.
Javanmard-Emamghissi H, Boyd-Carson H, Hollyman M, Doleman B, Adiamah A, Lund JN, et al. The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study. Tech Coloproctol. 2020 Jul 15:1–11. doi: 10.1007/s10151-020-02297-4. Epub ahead of print. Erratum in: Tech Coloproctol. 2020 Sep 25;: PMID: 32671661; PMCID: PMC7362319.
Parreira JG, Campos T, Antunes PSL, Perlingeiro JAG, Assef JC. Management of non traumatic surgical emergencies during the COVID-19 pandemia. Rev Col Bras Cir. 2020;47:e20202614. Portuguese, English. doi: 10.1590/0100-6991e-20202614. Epub 2020 Jul 3. PMID: 32638911.
Orthopoulos G, Santone E, Izzo F, Tirabassi M, Pérez-Caraballo AM, Corriveau N, et al. Increasing incidence of complicated appendicitis during COVID-19 pandemic. Am J Surg. 2020 Sep 28:S0002-9610(20)30595-X. doi: 10.1016/j.amjsurg.2020.09.026. Epub ahead of print. PMID: 33012500; PMCID: PMC7521886.
Romero J, Valencia S, Guerrero A. Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Changes in Clinical Presentation and CT Findings. J Am Coll Radiol. 2020 Aug;17(8):1011-1013. doi: 10.1016/j.jacr.2020.06.002. Epub 2020 Jun 28. PMID: 32610104; PMCID: PMC7321660.
Ganesh R, Lucocq J, Ekpete NO, Ain NU, Lim SK, Alwash A, et al. Management of appendicitis during COVID-19 pandemic; short-term outcomes. Scott Med J. 2020 Nov;65(4):144-148. doi: 10.1177/0036933020956316. Epub 2020 Sep 2. PMID: 32878574; PMCID: PMC7481653.
Suwanwongse K, Shabarek N. Successful Conservative Management of Acute Appendicitis in a Coronavirus Disease 2019 (COVID-19) Patient. Cureus. 2020 Apr 26;12(4):e7834. doi: 10.7759/cureus.7834. PMID: 32467809; PMCID: PMC7250521.
Fugazzola P, Ceresoli M, Agnoletti V, Agresta F, Amato B, Carcoforo P, et al. The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition). World J Emerg Surg. 2020 Mar 10;15(1):19. doi: 10.1186/s13017-020-00298-0. PMID: 32156296; PMCID: PMC7063712.
Patkova B, Svenningsson A, Almström M, Eaton S, Wester T, Svensson JF.. Nonoperative Treatment Versus Appendectomy for Acute Nonperforated Appendicitis in Children: Five-year Follow Up of a Randomized Controlled Pilot Trial. Ann Surg. 2020 Jun;271(6):1030-1035. doi: 10.1097/SLA.0000000000003646. PMID: 31800496.