TY - JOUR
T1 - Surgical management of acute appendicitis during the European COVID-19 second wave
T2 - safe and effective
AU - For the ESTES SnapAppy Group
AU - Forssten, Maximilian Peter
AU - Kaplan, Lewis J.
AU - Tolonen, Matti
AU - Martinez-Casas, Isidro
AU - Cao, Yang
AU - Walsh, Thomas N.
AU - Bass, Gary Alan
AU - Mohseni, Shahin
AU - Ahl Hulme, Rebecka
AU - Biloslavo, Alan
AU - Kurihara, Hayato
AU - Pereira, Jorge
AU - Pourlotfi, Arvid
AU - Ryan, Éanna J.
AU - Louri, Nayef
AU - Nedham, Fatema
AU - Walsh, Thomas Noel
AU - Hashem, Jamal
AU - Corbally, Martin
AU - Farhan, Abeer
AU - Al Hamad, Hamad
AU - Elhennawy, Rawan
AU - AlKooheji, Mariam
AU - AlYusuf, Manar
AU - Aknouche, Wissal
AU - Zeidan, Anas A.
AU - Alsaffar, Yusuf S.
AU - Lipping, Edgar
AU - Talving, Peep
AU - Saar, Sten
AU - Graumann, Katrina
AU - Kibuspuu, Liis
AU - Harkov, Eduard
AU - Aaltonen, Gisele
AU - Sillman, Iines S.
AU - Haapanen, Sami
AU - Lampela, Hanna
AU - Sammalkorpi, Henna
AU - Eskola, Sofia
AU - Laakso, Altti
AU - Back, Johan
AU - Kettunen, Ulla
AU - Nummi, Antti M.
AU - Szwedyc, Anika
AU - Nykänen, Taina
AU - Rantala, Rolle
AU - Mäkäräinen-Uhlbäck, Elisa J.
AU - Meriläinen, Sanna A.
AU - Huhta, Heikki I.
AU - Shaked, Gad
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2023/2/1
Y1 - 2023/2/1
N2 - 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 ≥ 15 years 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.
AB - 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 ≥ 15 years 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.
KW - Acute appendicitis
KW - Appendectomy
KW - COVID-19
KW - Observational cohort
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=85146556779&partnerID=8YFLogxK
U2 - 10.1007/s00068-022-02149-w
DO - 10.1007/s00068-022-02149-w
M3 - Article
C2 - 36658305
AN - SCOPUS:85146556779
SN - 1863-9933
VL - 49
SP - 57
EP - 67
JO - European Journal of Trauma and Emergency Surgery
JF - European Journal of Trauma and Emergency Surgery
IS - 1
ER -