Impact of the COVID-19 pandemic on acute appendicitis in children

Abstract

Background and objectives

Since the COVID-19 pandemic confinement was established in Spain on March 9, 2020, the number of visits to the pediatric Emergency Department (ED) has decreased dramatically, probably due to the fear of parents becoming infected in the hospital environment. The aim of this work was to analyze the medium-term consequences during the first 9 months after the onset of the COVID-19 pandemic in children with acute appendicitis (AA).

Material and methods

A retrospective study was performed on children operated on for AA in our institution between 2017 and 2020, who were distributed in two groups according to the date of surgery: COVID-19 group (after March 9, 2020) and control group (before March 9, 2020). Demographic variables, associated symptoms, time from symptoms onset, hospital stay, rate of complicated AA and postoperative complications were analyzed.

Results

A total of 1274 patients were included (288 COVID group; 986 control group), without demographic differences. Time from symptom onset was significantly longer in COVID-19 group (34.5 vs. 24.2 h; p = 0.021), although no differences in associated symptoms were observed between both groups. COVID-19 group presented a higher rate of complicated AA (20.1% vs. 14%; OR: 1.55; CI 95% [1.10–2.18]; p = 0.008), a longer hospital stay (3.5 vs. 2.8 days; p = 0.042) as well as a higher rate of postoperative complications (21.5% vs. 15.7%; OR: 1.47; CI 95% [(1.06–2.04)]; p = 0.008).

Conclusion

In our experience there was a negative medium-term effects of the COVID-19 pandemic on children with acute appendicitis: delayed ED visits, increased rate of complicated AA, increased hospital stay and increased postoperative complications.

Resumen

Antecedentes y objetivos

Desde el inicio del confinamiento el 9 de marzo de 2020 por la pandemia COVID-19 en España, el número de visitas al Servicio de Urgencias Pediátricas ha disminuido drásticamente, probablemente por el temor a que los padres se infecten en el entorno hospitalario. El objetivo de este trabajo es analizar las consecuencias a medio plazo durante los primeros 9 meses tras el inicio de la pandemia de COVID-19 en niños con apendicitis aguda (AA).

Material y métodos

Se realizó un estudio retrospectivo en niños operados de AA en nuestra institución entre 2017-2020, que se distribuyeron en 2 grupos según la fecha de la cirugía: grupo COVID-19 (posterior al 9 de marzo de 2020) y grupo control (anterior al 9 de marzo de 2020). Se analizaron variables demográficas, síntomas asociados, tiempo desde el inicio de síntomas, estancia hospitalaria, tasa de AA complicadas y complicaciones postoperatorias.

Resultados

Se incluyeron 1.274 pacientes (288 en el grupo COVID-19; 986 en el grupo control), sin diferencias demográficas. El tiempo desde el inicio de los síntomas fue significativamente mayor en los pacientes del grupo COVID-19 (34,5 vs. 24,2 h; p = 0,021), sin diferencias en los síntomas asociados entre ambos grupos. Los pacientes del grupo COVID-19 presentaron una mayor tasa de AA complicadas (20,1 vs. 14%; OR: 1,55; IC 95% [1,10-2,18]; p = 0,008), una estancia hospitalaria más prolongada (3,5 vs. 2,8 días; p = 0,042) y mayor tasa de complicaciones postoperatorias (21,5 vs. 15,7%; OR: 1,47; IC 95% [1,06-2,04]; p = 0,008).

Conclusión

En nuestra experiencia hubo efectos negativos a medio plazo de la pandemia de COVID-19 en los niños con AA: retraso en las visitas a Urgencias, mayor tasa de AA complicadas, estancia hospitalaria más prolongada y mayores complicaciones postoperatorias.