The pandemic impact on appendicitis management in Region Jönköping County
Ida Järvesjö, Fredrik Hammarskjöld, Knut Taxbro, Kalle LanderholmAbstract
Introduction
The coronavirus disease 2019 (COVID-19) put health care systems under major strain, and lessons may be learned for future challenges. This study aimed to investigate the effects of COVID-19 on appendicitis care in a Swedish region.
Methods
A retrospective observational registry study of patients diagnosed with acute appendicitis at either of three hospitals in Region Jönköping County (population 370 000) was conducted. Two cohorts were identified; a pre-pandemic group from April 2017–December 2019, and a pandemic group from April 2020–March 2021. The primary outcome was time from index hospital presentation to start of surgery.
Results
1523 patients of all ages were diagnosed with appendicitis, 1.1 per day in both pre-pandemic and pandemic periods. Of them, 1268 patients underwent appendectomy with no difference in operative rates between pre-pandemic and pandemic groups (P = 0.55). The duration from index hospital presentation to start of surgery was not prolonged during the pandemic (11.2 h [95% c.i. 7.0–17.9] versus 11.3 [7.5–19.2], P = 0.176). The proportion of laparoscopic appendectomies increased from 63.5% to 78.4% in the pandemic group (P = 0.001). The incidence of surgical complications Clavien-Dindo grade ≥2 remained constant at around 3% in both groups and other post-operative complications did not differ between the groups.
Discussion
No delay from index hospital presentation until start of surgery for appendectomy was observed. Admissions, operative rates and frequency of postoperative complications remained unchanged, whereas laparoscopic approach increased. This suggests that the acute surgical flow for appendectomies was largely unaffected during the COVID-19 pandemic, despite increased strain on the health care system.