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Abstract
Acute appendicitis (AA) is the most frequent cause of acute surgical abdomen in pediatrics. During the COVID-19 pandemic, lockdown slowed surgical processes, delaying medical consultations.
Objective: To analyze the impact of the pandemic on the presentation and management of acute appendicitis.
Patients and Method: Retrospective cohort, which included patients under 15 years of age seen in the emergency department (ED) with a diagnosis of acute appendicitis, from March to December of the pre-pandemic period of 2018 and the pandemic period in 2020. Demographic data, symptoms, treatment, and complications were analyzed. Patients were divided into groups based on the severity of the condition. A statistically significant difference of p < 0.05 was demonstrated.
Results: 629 patients with AA from both periods were included. The evolution time from the onset of symptoms to the consultation of all patients with AA in the pandemic was longer, with 41.2 hours versus 35.5 hours in the prepandemic period (p < 0.05), and in the subgroup of complicated acute appendicitis (CAA), it was 59.5 hours versus 45.4 hours in the pandemic and pre-pandemic periods (p < 0.01), respectively. Admission to the intensive care unit was higher in the pandemic, with 3.9% versus 0.6% in the pre-pandemic period (p < 0.05). In the case of appendicular phlegmon, it had greater hospital stay in the pandemic with 11.6 days versus 7.8 days in the pre-pandemic period (p < 0.05) and longer antibiotic treatment with 17 days in the pandemic versus 11.1 days in the prepandemic period (p < 0.05). The surgical approach in the pandemic was mainly laparoscopic with 62.4% (p < 0.001).
Conclusion: During the pandemic, there was a delay in consultation and a greater requirement for intensive management in patients with acute appendicitis. The hospital stays and antibiotic treatment of appendiceal phlegmon were longer and the laparoscopic technique was the surgical approach of choice.
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