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Meta-Analysis
. 2021 Jul;25(7):1905-1915.
doi: 10.1007/s11605-021-04988-1. Epub 2021 Mar 26.

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Sameh Hany Emile  1 , Hytham K S Hamid  2 , Sualeh Muslim Khan  3 , George N Davis  4
Affiliations
Meta-Analysis

Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Sameh Hany Emile et al. J Gastrointest Surg. 2021 Jul.

Abstract

Background: Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19.

Methods: This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess.

Results: Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8-70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p < 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4-23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4-7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM.

Conclusion: NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates.

Keywords: Appendicitis; COVID-19; Meta-analysis; Non-operative management; Outcome; Systematic review.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow chart
Fig. 2
Fig. 2
Forest plot for the odds ratio of the NOM application rate before and after COVID-19
Fig. 3
Fig. 3
Forest plot for the weighted mean failure rate of NOM
Fig. 4
Fig. 4
Forest plot for the weighted mean complication rate of NOM
Fig. 5
Fig. 5
Forest plot for the odds ratio of complications after NOM versus after appendectomy
Fig. 6
Fig. 6
Funnel plot for publication bias assessment
See this image and copyright information in PMC

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