Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis

Background Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. Methods This was a PRISMA-compli...

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Veröffentlicht in:Journal of gastrointestinal surgery 2021-07, Vol.25 (7), p.1905-1915
Hauptverfasser: Emile, Sameh Hany, Hamid, Hytham K. S., Khan, Sualeh Muslim, Davis, George N.
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container_end_page 1915
container_issue 7
container_start_page 1905
container_title Journal of gastrointestinal surgery
container_volume 25
creator Emile, Sameh Hany
Hamid, Hytham K. S.
Khan, Sualeh Muslim
Davis, George N.
description Background Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. Methods This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess. Results Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8–70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p < 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4–23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4–7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM. Conclusion NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates.
doi_str_mv 10.1007/s11605-021-04988-1
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S. ; Khan, Sualeh Muslim ; Davis, George N.</creator><creatorcontrib>Emile, Sameh Hany ; Hamid, Hytham K. S. ; Khan, Sualeh Muslim ; Davis, George N.</creatorcontrib><description>Background Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. Methods This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess. Results Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8–70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p &lt; 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4–23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4–7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM. Conclusion NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-021-04988-1</identifier><identifier>PMID: 33772399</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Appendectomy ; Appendectomy - adverse effects ; Appendicitis ; Appendicitis - epidemiology ; Appendicitis - surgery ; Child ; Coronaviruses ; COVID-19 ; Female ; Gastroenterology ; Humans ; Male ; Medicine ; Medicine &amp; Public Health ; Meta-analysis ; Pandemics ; Review ; Review Article ; SARS-CoV-2 ; Surgery ; Systematic review</subject><ispartof>Journal of gastrointestinal surgery, 2021-07, Vol.25 (7), p.1905-1915</ispartof><rights>The Society for Surgery of the Alimentary Tract 2021</rights><rights>2021. 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S.</creatorcontrib><creatorcontrib>Khan, Sualeh Muslim</creatorcontrib><creatorcontrib>Davis, George N.</creatorcontrib><title>Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Background Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. Methods This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess. Results Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8–70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p &lt; 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4–23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4–7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM. 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S.</au><au>Khan, Sualeh Muslim</au><au>Davis, George N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>25</volume><issue>7</issue><spage>1905</spage><epage>1915</epage><pages>1905-1915</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Background Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. Methods This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess. Results Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8–70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p &lt; 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4–23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4–7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM. Conclusion NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>33772399</pmid><doi>10.1007/s11605-021-04988-1</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-7854-5244</orcidid><oa>free_for_read</oa></addata></record>
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source MEDLINE; SpringerNature Journals
subjects Adult
Appendectomy
Appendectomy - adverse effects
Appendicitis
Appendicitis - epidemiology
Appendicitis - surgery
Child
Coronaviruses
COVID-19
Female
Gastroenterology
Humans
Male
Medicine
Medicine & Public Health
Meta-analysis
Pandemics
Review
Review Article
SARS-CoV-2
Surgery
Systematic review
title Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis
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