Maximilian Peter Forssten (Örebro / SE), Lewis J Kaplan (Philadelphia, PA / US), Matti Tolonen (Helsinki / FI), Isidro Martínez Casas (Huelva / ES), Yang Cao (Örebro / SE), Thomas N Walsh (Riffa / BH), Gary Alan Bass (Philadelphia, PA / US; Örebro / SE), Shahin Mohseni (Örebro / SE)
Abstract text (incl. references and figure legends)
Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy.
Material & Methods: Data was derived from the prospective, multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥15 years who underwent appendectomy for appendicitis (November 2020 - May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model.
Results: Appendectomy for acute appendicitis was performed in 4047 patients during the 2nd and 3rd European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications.
Conclusions: During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.
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