학술논문
Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective
Document Type
Author
Forssten, Maximilian Peter; Kaplan, Lewis J.; Tolonen, Matti; Martinez-Casas, Isidro; Cao, Yang; Walsh, Thomas N.; Bass, Gary Alan; Mohseni, Shahin; Ahl Hulme, Rebecka; Biloslavo, Alan; Kurihara, Hayato; Pereira, Jorge; Pourlotfi, Arvid; Ryan, Éanna J.; Louri, Nayef; Nedham, Fatema; Walsh, Thomas Noel; Hashem, Jamal; Corbally, Martin; Farhan, Abeer; Al Hamad, Hamad; Elhennawy, Rawan; AlKooheji, Mariam; AlYusuf, Manar; Aknouche, Wissal; Zeidan, Anas A.; Alsaffar, Yusuf S.; Lipping, Edgar; Talving, Peep; Saar, Sten; Graumann, Katrina; Kibuspuu, Liis; Harkov, Eduard; Aaltonen, Gisele; Sillman, Iines S.; Haapanen, Sami; Lampela, Hanna; Sammalkorpi, Henna; Eskola, Sofia; Laakso, Altti; Back, Johan; Kettunen, Ulla; Nummi, Antti M.; Szwedyc, Anika; Nykänen, Taina; Rantala, Rolle; Mäkäräinen-Uhlbäck, Elisa J.; Meriläinen, Sanna A.; Huhta, Heikki I.; Rintala, Jukka M.J.; Laitakari, Kirsi E.M.; Lietzen, Elina; Salminen, Paulina; Rapola, Risto K.A.; Zangouri, Vahid; Karami, Mohammad Y.; Tahmasebi, Sedigheh; Akrami, Majid; Golchini, Alireza; Bahrami, Faranak; Johnston, Sean M.; Lim, Sean T.; Ahonkhai, Irele Ifijeh; Eltagani, Eltahir; Ryan, Odhran K.; O’Driscoll-Collins, Ailbhe; O’Neill, Aine; Penny, Zakiya; Kelly, Orlaith; Cullinane, Carolyn; Reynolds, Ian; Heneghan, Helen; Martin, Sean; Winter, Des; Davey, Matthew; Alkhattab, Maha; Lowery, Aoife J.; Kerin, Michael J.; Hogan, Aisling M.; Davey, Martin S.; Oh, Ke En; Kabir, Syed Mohammad Umar; Huan, Huilun; Aziz, Charlotte; Sugrue, Michael; Ryan, Jessica M.; Connelly, Tara M.; Alhazmi, Mohammad; Al-Mukhaizeem, Youssef; Cooke, Fiachra; Neary, Peter M.; Hill, Arnold D.K.; Boland, Michael R.; Lloyd, Angus J.; Fallon, Frances; Cleere, Eoin F.; Toale, James; Boland, Patrick A.; Devine, Michael; Keady, Conor; Caragounis, Eva Corina
Source
European Journal of Trauma and Emergency Surgery. 49:57-67
Subject
Language
English
ISSN
1863-9933
1615-3146
1615-3146
Abstract
Introduction: 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. Methods: Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15years 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. Results: 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. Conclusion: 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.