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Review
. 2022 Aug:45:100512.
doi: 10.1016/j.ijso.2022.100512. Epub 2022 Jul 12.

Incidence of complicated appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis

Abduljubbar Kariya  1 , Chonlada Krutsri  2 , Pongsasit Singhatas  2 , Preeda Sumritpradit  2 , Tharin Thampongsa  2 , Panuwat Lertsitthichai  3 , Napaphat Phoprom  3
Affiliations
Review

Incidence of complicated appendicitis during the COVID-19 pandemic: A systematic review and meta-analysis

Abduljubbar Kariya et al. Int J Surg Open. 2022 Aug.

Abstract

Introduction: Measures taken to prevent the spread of coronavirus disease 2019 (COVID-19) slow surgical processes, and patients are avoiding presenting at emergency departments during the outbreak because of fears of contracting the contagious disease. To analyze the rate of complicated appendicitis before and during the COVID-19 pandemic.

Methods: We systematically reviewed the PubMed and SCOPUS databases for articles published from 2000 to 2021. Including the retrospective review data collected from our hospital of patients aged ≥18 years old who were diagnosed with acute appendicitis. The primary outcome of complicated appendicitis incidence was compared between before and during the COVID-19 pandemic period. We performed a meta-analysis using a random-effects model analysis.

Results: A total 3559 patients were included for meta-analysis. The overall rate of complicated appendicitis was significantly higher during the pandemic (relative risk, 1.55; 95% confidence interval [CI], 1.26-1.89). The time from onset of symptoms to hospitalisation was 0.41 h longer during the pandemic, which was not significantly different (standardized mean difference, 0.41, 95% CI, -0.03 to 1.11). The operating time during the pandemic was significantly shorter than that before the pandemic (83.45 min and 71.65 min, p = 0.01).

Conclusion: There are correlation between the pandemic and severity of acute appendicitis. The higher rate of complicated appendicitis in the pandemic indicates that patients require timely medical attention and appropriate treatment despite fears of contracting disease.

Keywords: Acute appendicitis; COVID-19; Complicated appendicitis; Perforated appendicitis; SAR-CoV-2; Uncomplicated appendicitis.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
A study flow chart according to Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines (PRISMA).
Fig. 2
Fig. 2
Forest plot of complicated appendicitis before and COVID-19 pandemic period.
Fig. 3
Fig. 3
Forest plot of perforated appendicitis before and COVID-19 pandemic period.
Fig. 4
Fig. 4
Forest plot of gangrenous appendicitis before and COVID-19 pandemic period.
Fig. 5
Fig. 5
Forest plot of appendiceal abscess and phlegmon before and COVID-19 pandemic period.
Fig. 6
Fig. 6
Forest plot of length of hospital stay(LOS) before and COVID-19 pandemic period.
Fig. 7
Fig. 7
Forest plot of time from onset of symptom to hospitalisation before and COVID-19 pandemic period.
Fig. 8
Fig. 8
Funnel plot for detection of publication bias of complicated appendicitis.
See this image and copyright information in PMC

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