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Observational Study
. 2021 Dec;73(6):2205-2213.
doi: 10.1007/s13304-021-01126-z. Epub 2021 Jul 4.

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Alberto Sartori  1 , Mauro Podda  2 , Emanuele Botteri  3 , Roberto Passera  4 , Ferdinando Agresta  5 , Alberto Arezzo  6 ; CRAC Study Collaboration Group
Collaborators, Affiliations
Observational Study

Appendectomy during the COVID-19 pandemic in Italy: a multicenter ambispective cohort study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study)

Alberto Sartori et al. Updates Surg. 2021 Dec.

Abstract

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020.

Keywords: Appendectomy; Appendicitis; COVID-19 Pandemic; Machine learning.

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Conflict of interest statement

Alberto Sartori, Mauro Podda, Emanuele Botteri, Roberto Passera, Alberto Arezzo, Ferdinando Agresta have no conflict of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Variable importance for the top ten ML models
Fig. 3
Fig. 3
Variable importance for the best ML model (GLM)
See this image and copyright information in PMC

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