Evidence map›Paper›PMID 37578533›Full record

Observational studyLangenbeck's archives of surgery2023

Two-year outcomes of conservatively managed appendicitis during the COVID-19 pandemic-a multicentre cohort study.

N Habib Bedwani, C Smith, M Kelada, D K Patten, W K Mak, W English, V Shatkar

Erratum issuedAbstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Langenbeck's archives of surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
1.0field-weighted citation impact, top 23% of its field
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

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 6 institutions in 1 country.

N Habib BedwaniDigestive Diseases Centre, Barking, Havering and Redbridge University Hospital NHS Trust, London, UK. nader@cantab.net.
C SmithDepartment of General Surgery/Colorectal Surgery, Kings College Hospital NHS Foundation Trust, London, UK.
M KeladaFaculty of Medicine, Imperial College London, London, UK.
D K PattenDepartment of Surgery and Cancer, Imperial Centre for Translational and Experimental Medicine, London, UK.
W K MakDepartment of General Surgery/Colorectal Surgery, Royal Devon Healthcare NHS Foundation Trust, Exeter, Devon, UK.
W EnglishApplied Biomedical Engineering Group, University College London, London, UK.
V ShatkarDigestive Diseases Centre, Barking, Havering and Redbridge University Hospital NHS Trust, London, UK.
Barking, Havering And Redbridge University Hospitals NHS Trust · GBBarts Health NHS Trust · GBCleveland Clinic London · GBImperial College London · GBKing's College Hospital NHS Foundation Trust · GBRoyal Devon & Exeter NHS Foundation Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeDuring the COVID-19 pandemic, the new RCSEng guidelines resulted in appendicitis being more commonly managed conservatively to avoid aerosol-generating procedures. This resulted in shorter hospital stays without increased short-term complications. The 2-year outcomes of this change, specifically recurrence and re-admission rates remain unknown.

methodsWe conducted a multicentre, prospective, observational study including all adult patients treated as appendicitis after the implementation of the new surgical guidelines during the COVID-19 pandemic. Outcomes included initial management failure, re-admission rate, appendicitis recurrence, and interval appendicectomy. A historical cohort prior to the COVID-19 pandemic was used for comparison. Patients were followed up for 2-years post index admission. Categorical and continuous variables were compared using Fisher's exact test and Student's T or Mann-Whitney U tests as appropriate.

resultsSixty-three and 79 patients with appendicitis were included from four NHS trusts, before (A) and after (B) the new intercollegiate guidelines respectively. Operative management was used less frequently in cohort B (28/79 vs 52/63; p<0.001). More patients re-presented in cohort B (14/79 vs 3/63; p=0.020), but not when comparing only those managed conservatively (2/11 vs 13/52; p=1.000). A similar trend was observed for appendicitis recurrence although without statistical significance (2/63 vs 9/79; p=0.112); with loss of trend when comparing those managed conservatively-only (2/11 vs 9/52; p=1.000). Among all patients, four (2.8%) were found to have underlying neoplasia of which three were initially managed conservatively (3/63; 4.8%).

conclusionConservative management of appendicitis has previously been shown to have short-term benefits in expedited hospital discharge without early complications. The present study shows it has a higher readmission and appendicitis recurrence rates. The risks of this alongside missed/delayed management of neoplasia needs to be considered alongside the benefits including avoidance of aerosol-generating general anaesthesia and laparoscopy during the COVID-19 pandemic or similar future health crises. Small case numbers limit analysis.

Indexed as

AppendicitisCOVID-19AdultAnti-Bacterial AgentsAppendectomyHumansPandemicsProspective StudiesRetrospective StudiesAnti-Bacterial AgentsAppendicitisAppendicitis recurrenceCancerCOVID-19

Identifiers

PMID37578533
OpenAlexW4385798747

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.