Evidence map›Paper›PMID 33465496›Full record

Observational studyInternational journal of surgery (London, England)2021

Acute appendicitis management during the COVID-19 pandemic: A prospective cohort study from a large UK centre.

Ramez Antakia, Athanasios Xanthis, Fanourios Georgiades, Victoria Hudson, James Ashcroft, Siobhan Rooney, Aminder A Singh, John R O'Neill, Nicola Fearnhead, Richard H Hardwick and 2 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in International journal of surgery (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Ramez AntakiaDivision of Digestive Diseases, Addenbrooke's Hospital, Cambridge, UK. Electronic address: ramez.antakia@gmail.com.
Athanasios XanthisDivision of Digestive Diseases, Addenbrooke's Hospital, Cambridge, UK.
Fanourios GeorgiadesDepartment of Surgery, University of Cambridge, Cambridge, UK.
Victoria HudsonDivision of Digestive Diseases, Addenbrooke's Hospital, Cambridge, UK.
James AshcroftDivision of Digestive Diseases, Addenbrooke's Hospital, Cambridge, UK.
Siobhan RooneyDivision of Digestive Diseases, Addenbrooke's Hospital, Cambridge, UK.
Aminder A SinghDivision of Digestive Diseases, Addenbrooke's Hospital, Cambridge, UK.
John R O'NeillCambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge, UK.
Nicola FearnheadCambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK.
Richard H HardwickCambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge, UK.
R Justin DaviesCambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK.
John M H BennettCambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDuring the Covid-19 pandemic, non-operative management for acute appendicitis (AA) was implemented in the UK. The aim of this study was to determine the efficacy and outcomes of conservative versus surgical management of AA during the pandemic. MATERIALS &

methodsWe conducted an observational study in a tertiary referral centre. Data was collected from all patients (≥16 years) with a diagnosis of AA between November 1, 2019 to March 10, 2020 (pre-COVID period) and March 10, 2020 to July 5, 2020 (COVID period).

resultsA total of 116 patients in the pre-COVID period were included versus 91 in the COVID period. 43.1% (n = 50) of patients pre-COVID were classified as ASA 2 compared to 26.4% (n = 24) during the COVID period (p-value = 0.042). 72.5% (n = 66) of the patients during the COVID period scored as high risk using the Alvarado score compared to 24.1% (n = 28) in the pre-COVID period (p-value<0.001). We observed a significant increase in radiological evaluation, 69.8% versus 87.5% of patients had a CT in the pre-COVID and COVID periods respectively (p-value = 0.008). 94.9% of patients were managed operatively in the pre-COVID period compared to 60.4% in the COVID period (p-value<0.001). We observed more open appendicectomies (37.3% versus 0.9%; p-value<0.001) during the COVID period compared to the pre-COVID period. More abscess formation and free fluid were found intraoperatively in the COVID period (p-value = 0.021 and 0.023 respectively). Re-attendance rate due to appendicitis-related issues was significantly higher in the COVID period (p = 0.027).

conclusionRadiological diagnosis of AA was more frequent during the COVID period. More conservative management for AA was employed during the COVID-19 pandemic, and for those managed operatively an open approach was preferred. Intra-operative findings were suggestive of delayed presentation during the COVID period without this affecting the length of hospital stay.

Indexed as

COVID-19Acute DiseaseAdolescentAdultAgedAged, 80 and overAnti-Bacterial AgentsAppendectomyAppendicitisConservative TreatmentDelayed DiagnosisFemaleHumansLength of StayMaleMiddle AgedAnti-Bacterial AgentsAcute appendicitisAntibiotic therapyConservative managementCOVID-19Laparoscopic appendicectomyOpen surgery

Identifiers

PMID33465496
PMCPMC7985094

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.