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Meta-Analysis
. 2023 Nov 28;40(1):11.
doi: 10.1007/s00383-023-05594-9.

Management and outcomes of acute appendicitis in children during the COVID-19 pandemic: a systematic review and meta-analysis

Maria Enrica Miscia  1   2 , Giuseppe Lauriti  3   4 , Dacia Di Renzo  2 , Valentina Cascini  2 , Gabriele Lisi  1   2
Affiliations
Meta-Analysis

Management and outcomes of acute appendicitis in children during the COVID-19 pandemic: a systematic review and meta-analysis

Maria Enrica Miscia et al. Pediatr Surg Int. .

Abstract

The COVID-19 pandemic has changed the way to manage the emergencies, as people faced fear of the hospitals, with possible delay in the diagnosis. Moreover, clinicians had to rearrange protocols for diagnosis and treatment. We aimed to assess whether COVID-19 pandemic influenced severity of inflammation, management, and outcomes of acute appendicitis (AA), when compared to the pre-COVID era. Using defined search strategy, two independent investigators identified those studies comparing pediatric AA during COVID-19 pandemic versus the pre-COVID-19 period. Meta-analysis was performed using RevMan 5.3. Data are mean ± SD. Of 528 abstracts, 36 comparative studies were included (32,704pts). Time from symptoms onset to surgery was longer during the pandemics compared to the pre-COVID-19 (1.6 ± 0.9 versus 1.4 ± 0.9 days; p < 0.00001). Minimally Invasive Surgery was similar during COVID-19 (70.4 ± 30.2%) versus control period (69.6 ± 25.3%; p = ns). Complicated appendicitis was increased during the pandemics (35.9 ± 14.8%) compared to control period (33.4 ± 17.2%; p < 0.0001). Post-operative complications were comparable between these two groups (7.7 ± 6.5% versus 9.1 ± 5.3%; p = ns). It seems that the COVID-19 pandemic influenced the time of diagnosis, severity of inflammation, and type of surgery. However, the number of post-operative complications was not different between the two groups, leading to the conclusion that the patients were correctly managed. LEVEL OF EVIDENCE: Level 3 Meta-analysis on Level 3 studies.

Keywords: Acute appendicitis; COVID-19; Children; Meta-analysis; Systematic review.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Search strategy
Fig. 2
Fig. 2
Diagram of workflow in the systematic review and meta-analysis
Fig. 3
Fig. 3
Pre-operative data: forest plot comparison of patients during Covid-19 pandemic versus pre-Covid-19 era with regards age at presentation (a) and time from symptoms onset to surgery (b)
Fig. 4
Fig. 4
Management of AA: forest plot comparison of patients during Covid-19 pandemic versus pre-Covid-19 era with regards minimally invasive appendectomies (a), the incidence of complicated appendicitis (b), non-operative management of acute appendicitis (c), and the rate of negative appendicitis (d)
Fig. 4
Fig. 4
Management of AA: forest plot comparison of patients during Covid-19 pandemic versus pre-Covid-19 era with regards minimally invasive appendectomies (a), the incidence of complicated appendicitis (b), non-operative management of acute appendicitis (c), and the rate of negative appendicitis (d)
Fig. 5
Fig. 5
Post-operative outcomes: forest plot comparison of patients during Covid-19 pandemic versus pre-Covid-19 era with regards post-operative complications (a) and the length of hospital stay (b)
See this image and copyright information in PMC

References

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