COVID-19 opens the door for right iliac fossa pain treatment pathway
INTRODUCTION: The COVID-19 pandemic has increased the risks of surgery and management of common surgical conditions has changed, with greater reliance on imaging and conservative management. The negative appendectomy rate (NAR) in the UK has previously remained high. The aim of this study was to quantify pandemic-related changes in the management of patients with suspected appendicitis, including the NAR.
METHODS: A retrospective study was performed at a single high volume centre of consecutive patients aged over five years presenting to general surgery with right iliac fossa pain in two study periods: for two months before lockdown and for four months after lockdown. Pregnant patients and those with previous appendectomy, including right colonic resection, were excluded. Demographic, clinical, imaging and histological data were captured, and risk scores were calculated, stratifying patients into higher and lower risk groups. Data were analysed by age, sex and risk subgroups.
RESULTS: The mean number of daily referrals with right iliac fossa pain or suspected appendicitis reduced significantly between the study periods, from 2.92 before lockdown to 2.07 after lockdown (p<0.001). Preoperative computed tomography (CT) rates increased significantly from 22.9% to 37.2% (p=0.002). The NAR did not change significantly between study periods (25.5% prior to lockdown, 11.1% following lockdown, p=0.159). Twelve (75%) out of sixteen negative appendectomies were observed in higher risk patients aged 16-45 years who did not undergo preoperative CT. The NAR in patients undergoing CT was 0%.
CONCLUSIONS: Greater use of preoperative CT should be considered in risk stratified patients in order to reduce the NAR.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:104 |
|---|---|
| Enthalten in: |
Annals of the Royal College of Surgeons of England - 104(2022), 4 vom: 01. Apr., Seite 302-307 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Ball, A [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Appendectomy |
|---|
| Anmerkungen: |
Date Completed 04.04.2022 Date Revised 13.07.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1308/rcsann.2021.0213 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM334185807 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM334185807 | ||
| 003 | DE-627 | ||
| 005 | 20231225223155.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1308/rcsann.2021.0213 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1113.xml |
| 035 | |a (DE-627)NLM334185807 | ||
| 035 | |a (NLM)34882012 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Ball, A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a COVID-19 opens the door for right iliac fossa pain treatment pathway |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 04.04.2022 | ||
| 500 | |a Date Revised 13.07.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a INTRODUCTION: The COVID-19 pandemic has increased the risks of surgery and management of common surgical conditions has changed, with greater reliance on imaging and conservative management. The negative appendectomy rate (NAR) in the UK has previously remained high. The aim of this study was to quantify pandemic-related changes in the management of patients with suspected appendicitis, including the NAR | ||
| 520 | |a METHODS: A retrospective study was performed at a single high volume centre of consecutive patients aged over five years presenting to general surgery with right iliac fossa pain in two study periods: for two months before lockdown and for four months after lockdown. Pregnant patients and those with previous appendectomy, including right colonic resection, were excluded. Demographic, clinical, imaging and histological data were captured, and risk scores were calculated, stratifying patients into higher and lower risk groups. Data were analysed by age, sex and risk subgroups | ||
| 520 | |a RESULTS: The mean number of daily referrals with right iliac fossa pain or suspected appendicitis reduced significantly between the study periods, from 2.92 before lockdown to 2.07 after lockdown (p<0.001). Preoperative computed tomography (CT) rates increased significantly from 22.9% to 37.2% (p=0.002). The NAR did not change significantly between study periods (25.5% prior to lockdown, 11.1% following lockdown, p=0.159). Twelve (75%) out of sixteen negative appendectomies were observed in higher risk patients aged 16-45 years who did not undergo preoperative CT. The NAR in patients undergoing CT was 0% | ||
| 520 | |a CONCLUSIONS: Greater use of preoperative CT should be considered in risk stratified patients in order to reduce the NAR | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Appendectomy | |
| 650 | 4 | |a Appendicitis | |
| 650 | 4 | |a Clinical Decision-Making | |
| 650 | 4 | |a Diagnosis | |
| 650 | 4 | |a Tomography | |
| 650 | 4 | |a X-Ray | |
| 700 | 1 | |a Mansfield, A |e verfasserin |4 aut | |
| 700 | 1 | |a Taylor, B |e verfasserin |4 aut | |
| 700 | 1 | |a Sheerin, F |e verfasserin |4 aut | |
| 700 | 1 | |a Wickins, J |e verfasserin |4 aut | |
| 700 | 1 | |a Akhtar, Z |e verfasserin |4 aut | |
| 700 | 1 | |a Bhangu, A |e verfasserin |4 aut | |
| 700 | 1 | |a Karandikar, S |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Annals of the Royal College of Surgeons of England |d 1947 |g 104(2022), 4 vom: 01. Apr., Seite 302-307 |w (DE-627)NLM000012912 |x 1478-7083 |7 nnns |
| 773 | 1 | 8 | |g volume:104 |g year:2022 |g number:4 |g day:01 |g month:04 |g pages:302-307 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1308/rcsann.2021.0213 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 104 |j 2022 |e 4 |b 01 |c 04 |h 302-307 | ||