SARS-CoV-2 Infection is Not Associated with a Higher Rate of Post-operative Complications in Adult Appendectomy Patients in Peru: Cross-sectional Study

Overview

Journal Ann Med Surg (Lond)

Publisher Wolters Kluwer

Specialty Medical Education

Date 2021 Jul 26

PMID 34306672

Citations 1

Authors

Eduardo Huaman Egoavil

Lacey LaGrone

Regina Ugarte Oscco

Sergio Endo Ramos

Alex Diaz Baltazar

Cesar Vergel Cabrera

Affiliations

Soon will be listed here.

Abstract

Background: We present outcomes of patients with SARS-CoV-2 undergoing appendectomy in order to aid in clarification of current controversies regarding safety of therapeutic options for emergency surgical diseases in patients with SARS-CoV-2. Peru has the greatest number of per capita deaths due to SARS-CoV-2 of any country and is one of few with a COVID-dedicated hospital.

Materials And Methods: This prospective observational study included all adult patients with acute appendicitis admitted to an urban, public, COVID-dedicated hospital over two months. Baseline characteristics and post-operative outcomes at 28 days are reported.

Results: 58 patients, 35 male and 23 female, ages 15-73 years with SARS-CoV-2 as diagnosed by IgM (12%), IgG (19%) or both (69%) and acute appendicitis as diagnosed using the Alvarado Score and confirmed intraoperatively were enrolled. All patients presented with right lower quadrant pain, 86% with leukocytosis, 88% with nausea/emesis and no patients with respiratory complaints. All patients underwent open appendectomy, 90% under regional anesthesia. Average operative time was 54±25 min, length of stay 2.5±1.5 days. 14% of patients had a post-operative complication, all were minor, four (7%) incisional surgical site infections, one (2%) organ space, and three (5%) incisional seromas, no deaths or serious complications.

Conclusion: Open surgical management of acute appendicitis with regional anesthesia in adults with pre-operative diagnosis of SARS-CoV-2 is feasible and not associated with an increased frequency or severity of post-operative complications, longer operative time, or extended hospitalization as compared to reports in similar patients without SARS-CoV-2.

Citing Articles

Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective.

Forssten M, Kaplan L, Tolonen M, Martinez-Casas I, Cao Y, Walsh T Eur J Trauma Emerg Surg. 2023; 49(1):57-67.

PMID: 36658305 PMC: 9851576. DOI: 10.1007/s00068-022-02149-w.

References

Balibrea J, Badia J, Rubio Perez I, Antona E, Alvarez Pena E, Garcia Botella S . Surgical Management of Patients With COVID-19 Infection. Recommendations of the Spanish Association of Surgeons. Cir Esp (Engl Ed). 2020; 98(5):251-259. PMC: 7270428. DOI: 10.1016/j.ciresp.2020.03.001. View

Delliere S, Salmona M, Minier M, Gabassi A, Alanio A, Le Goff J . Evaluation of the COVID-19 IgG/IgM Rapid Test from Orient Gene Biotech. J Clin Microbiol. 2020; 58(8). PMC: 7383543. DOI: 10.1128/JCM.01233-20. View

Lei S, Jiang F, Su W, Chen C, Chen J, Mei W . Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020; 21:100331. PMC: 7128617. DOI: 10.1016/j.eclinm.2020.100331. View

Katkhouda N, Mason R, Towfigh S, Gevorgyan A, Essani R . Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg. 2005; 242(3):439-48. PMC: 1357752. DOI: 10.1097/01.sla.0000179648.75373.2f. View

Pautrat K, Chergui N . SARS-CoV-2 infection may result in appendicular syndrome: Chest CT scan before appendectomy. J Visc Surg. 2020; 157(3S1):S63-S64. PMC: 7158827. DOI: 10.1016/j.jviscsurg.2020.04.007. View

Collard M, Lakkis Z, Loriau J, Mege D, Sabbagh C, Lefevre J . [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; 157(3):S33-S43. PMC: 7190476. DOI: 10.1016/j.jchirv.2020.04.014. View

Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G . STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg. 2019; 72:156-165. DOI: 10.1016/j.ijsu.2019.11.002. View

Doglietto F, Vezzoli M, Gheza F, Lussardi G, Domenicucci M, Vecchiarelli L . Factors Associated With Surgical Mortality and Complications Among Patients With and Without Coronavirus Disease 2019 (COVID-19) in Italy. JAMA Surg. 2020; 155(8):691-702. PMC: 7439107. DOI: 10.1001/jamasurg.2020.2713. View

Alvarado A . A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986; 15(5):557-64. DOI: 10.1016/s0196-0644(86)80993-3. View

10.

Shin C, Roh Y, Kim J . Delayed appendectomy versus early appendectomy in the treatment of acute appendicitis: a retrospective study. World J Emerg Surg. 2014; 9(1):8. PMC: 3900735. DOI: 10.1186/1749-7922-9-8. View

11.

. Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study. Surg Endosc. 2018; 32(8):3450-3466. PMC: 6061087. DOI: 10.1007/s00464-018-6064-9. View

12.

Thompson J, Baxter B, Allison J, Johnson F, Lee K, Park W . Temporal patterns of postoperative complications. Arch Surg. 2003; 138(6):596-602; discussion 602-3. DOI: 10.1001/archsurg.138.6.596. View

13.

Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani M, Delaney C . COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period. Ann Surg. 2020; 272(1):e27-e29. PMC: 7188030. DOI: 10.1097/SLA.0000000000003925. View

14.

Tominaga G, Staudenmayer K, Shafi S, Schuster K, Savage S, Ross S . The American Association for the Surgery of Trauma grading scale for 16 emergency general surgery conditions: Disease-specific criteria characterizing anatomic severity grading. J Trauma Acute Care Surg. 2016; 81(3):593-602. DOI: 10.1097/TA.0000000000001127. View

15.

Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A . Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020; 15(1):27. PMC: 7386163. DOI: 10.1186/s13017-020-00306-3. View

16.

Markides G, Subar D, Riyad K . Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg. 2010; 34(9):2026-40. DOI: 10.1007/s00268-010-0669-z. View

17.

Di Saverio S, Sibilio A, Giorgini E, Biscardi A, Villani S, Coccolini F . The NOTA Study (Non Operative Treatment for Acute Appendicitis): prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic acid) for treating patients with right lower quadrant abdominal pain and long-term follow-up of.... Ann Surg. 2014; 260(1):109-17. DOI: 10.1097/SLA.0000000000000560. View

18.

Podda M, Cillara N, Di Saverio S, Lai A, Feroci F, Luridiana G . Antibiotics-first strategy for uncomplicated acute appendicitis in adults is associated with increased rates of peritonitis at surgery. A systematic review with meta-analysis of randomized controlled trials comparing appendectomy and non-operative.... Surgeon. 2017; 15(5):303-314. DOI: 10.1016/j.surge.2017.02.001. View

19.

. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020; 396(10243):27-38. PMC: 7259900. DOI: 10.1016/S0140-6736(20)31182-X. View

20.

Gomes C, Sartelli M, Di Saverio S, Ansaloni L, Catena F, Coccolini F . Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg. 2015; 10:60. PMC: 4669630. DOI: 10.1186/s13017-015-0053-2. View