Emergency surgery in a large urban area community hospital during SARS-CoV-2 pandemic. An interim analysis on acute appendicitis

Abstract text (incl. references and figure legends)

Background Literature highlights a decrease in surgical treated appendicitis with an increased severity during the COVID-19 pandemic. The aim of this study was to analyse the effect of COVID lock-down on the population with appendicitis comparing clinical-pathologic data and outcome in two matching period (pre-pandemic and pandemic era) Materials and methods A retrospective analysis of patients admitted to two community urban hospital in Rome with diagnosis of Acute Appendicitis (AA) before and after the COVID-19 pandemic was performed. We compared patients patients with acute appendicitis in three groups named A (Pre Covid), B (Early Pandemic), and C (Late Pandemic). We evaluate the differences between the three groups in terms of onset of symptoms and severity, procedure difficulty, conversion rate, and short-term outcome. Results A total of 310 patients were identified. The time interval from onset of symptoms to arrival in the Emergency Department was significantly longer in both pandemic group; there was also a significantly longer time to surgery comparing to group A. The risk of complicated AA was higher in both pandemic groups. A significantly higher grade of difficulty was detected in both Covid-groups. However, no differences were observed in conversion rate. Post-operative complications rate showed no significant difference among all three groups. No patients was tested positive for SARS CoV-2 post-operatively. Conclusion AA treatment was comparable to pre-covid period in-hospital pre-surgery stay and early post-operative outcome. With an accurate respect of Pandemic Protocol is possible to maintain a high and safe standard of care for patients with acute appendicitis.

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