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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)

2021; Springer Science+Business Media; Volume: 73; Issue: 6 Linguagem: Inglês

10.1007/s13304-021-01126-z

2038-3312

Alberto Sartori, Mauro Podda, Emanuele Botteri, Roberto Passera, Ferdinando Agresta, Alberto Arezzo, Mario Guerrieri, Monica Ortenzi, Fabio Cavallo, Monica Zese, Daniela Prando, Enrico Restini, Pasquale Cianci, Paolo Millo, Riccardo Brachet Contul, Alessandra Serrao, F. Abatini, Donato F. Altomare, Arcangelo Picciariello, G Chetta, Fabrizia Lattanzio, Valeria Tonini, Gregorio Tugnoli, Elio Jovine, Laura Mastrangelo, L Sartarelli, Antonio Frena, Anna Malpaga, Giacomo Bertelli, Giusto Pignata, Jacopo Andreuccetti, Silvia Sanna, B. Lares, Raffaele Sechi, Nicola Cillara, Adolfo Pisanu, Daniele Delogu, Giovanni Ciaccio, M. Farulla, Massimiliano Casati, Letizia Laface, Maurizio De Luca, Domenico Russello, Saverio Latteri, Mauro Longoni, E. Masci, S Vigna, Fabio Cesare Campanile, Nicholas J. Foti, Pasquale Lepiane, Andrea Balla, Fulvio Cantore, V. Raveglia, Felice Borghi, Giorgio Giraudo, Augusto Verzelli, Andrea Budassi, Alberto Patriti, Domitilla Foghetti, U. Montin, L. Amadio, Gabriele Anania, Cristina Bombardini, Niccolò Fabbri, Carlo V. Feo, Fabio Cianchi, Andrea Manetti, Matteo Lucchese, Emanuele Soricelli, Graziano Ceccarelli, M. Patiti, Marco Frascio, Cesare Stabilini, Marco Filauro, Andrea Barberis, Marina Troian, Carlo Nagliati, Roberto Campagnacci, Angela Maurizi, Stefano Berti, Andrea Gennai, A. Marvaso, Dario D’Antonio, Carlo V. Feo, Nicolò Fabbri, Laura T Mazzola, Federico Selvaggi, S. Carini, Filippo Costanzo, Luigi Boccia, Annalisa Pascariello, Nicola Perrotta, Marta Celiento, Enrico Opocher, Marco Giovenzana, M. Stella, Francesco Ferrara, Luigi Boni, E Abate, Corrado Da Lio, Vittorio Valli, Roberta Gelmini, Fernando Tadeu Serra, Micaela Piccoli, Débora Gozzo, A Gattolin, Diego Sasia, Alessandro Balani, Barbara Petronio, Pietro Giorgio Calò, Gian Luigi Canu, E. Contarini, Giacomo Piatto, Nereo Vettoretto, Michela Caprioli, Marco Braga, Maria Francesca Chiappetta, Pietro Maida, Pasquale Tammaro, Giovanni Domenico De Palma, Marco Milone, Vincenzo Bottino, Alfonso Canfora, Federico Selvaggi, Giulia Bagaglini, Antonino Agrusa, Mirko Barone, Antonino Mirabella, Marco V. Marino, Gaspare Gulotta, G. Romano, Mario Sorrentino, Stefano Ferfoglia, Vincenzo Papagni, S. Eramo, Carlo Boselli, Massimo Basti, Valerio Caracino, Gianluigi Moretto, Marco Inama, Patrizio Capelli, Luigi Conti, Andrea Muratore, Manuela Cuoghi, A Zerbinati, Silvia Corso, Michele Ciocca Vasino, Mauro Montuori, Francesco Fidanza, Alessandra Lucchetta, Antonio Giuliani, G. Dinatale, Federico Zanzi, Anna Guariniello, Stefano Bonilauri, Giuseppe Frazzetta, M Garino, Chiara Marafante, A. Gioffrè, Stefano Rossi, Gabriele Sganga, Pietro Fransvea, Michele Grande, Leandro Siragusa, Giuseppe Sica, Martelli Paola, Domitilla Gaia Passantino, Marco Catani, Francesco Ricci, Enrico Lauro, Enzo Facci, Dario Parini, Mariano Fortunato Armellino, Giulio Argenio, Alberto Porcu, Teresa Perra, Paola Bordoni, Francesco Fleres, Amilcare Parisi, S Rossi, Roberto Saracco, Dario Bono, Tiziana Viora, Fiorenza Orlando, Alessandro Ferrero, Andrea Fontana, Paolo De Paolis, Diego Visconti, Francesco Quaglino, Felice Festa, S Palagi, Giacomo Lo Secco, Mario Morino, Marco E. Allaix, A Salzano, Giuseppe Tirone, Michele Motter, Giacomo Zanus, Nicola Passuello, Marco Massani, Roberta Tutino, Nicolò de Manzini, Susanna Terranova, Roberto Merenda, Susi Nordio, Sandro Zonta, Federico Lovisetto, Alfredo Guglielmi, Tommaso Campagnaro, Amedeo Elio, Michela Scollica, Pietro Maria Amodio, D. Giannotti, Stefano Olmi, Alberto Oldani,

Abdominal Surgery and Complications

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.