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Impact of the COVID-19 pandemic on management and outcomes of children with appendicitis: The Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study

Impact of the COVID-19 pandemic on management and outcomes of children with appendicitis: The Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study
Impact of the COVID-19 pandemic on management and outcomes of children with appendicitis: The Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study

Aim: To report the impact of the SARS-CoV-2 pandemic on management and outcomes of paediatric appendicitis in the UK and Ireland. Methods: Prospective, multicentre observational cohort study at general surgical and specialist paediatric surgical centres in the United Kingdom and Ireland from 1st April to 31st July 2020. Primary outcome was treatment strategy used for acute appendicitis. Results: This study includes 2002 children treated for acute appendicitis of a median age of 10 (range 1–15) years and 605 children from a similar data set pre pandemic from 2017. In the pandemic cohort 560/2002(28%) were initially treated non operatively of whom 125/560(22%) proceeded to appendicectomy within initial hospital admission. Non operative treatment wasn't used in the pre pandemic cohort. Diagnostic imaging use was greater during the pandemic compared to pre pandemic (54vs31%; p < 0.00001) but overall use of laparoscopy was similar during both time periods (62.4vs66.6%). Hospital readmission rate was lower (8.7vs13.9%; p = 0.0002) during the pandemic than pre pandemic and Re-intervention rate was similar (2.9vs2.6%;p = 0.42). In cases treated operatively negative appendicectomy rate was lower during the pandemic than pre pandemic (4.4vs15.4%; p =0.0001), and during the pandemic was amongst the lowest ever reported in the UK. Conclusion: COVID-19 has had a significant impact on the management of children with appendicitis in the UK and Ireland. The rate of imaging and the use of non operative management increased, whilst the negative appendicectomy rate reduced. Overall, patient outcomes have not been adversely impacted by change in management during the pandemic. conclusion: Level I. Type of study: Prognosis study.

Appendicitis, COVID-19, Negative appendicectomy, Outcomes
0022-3468
380-385
Bethell, George S
c7a62cc1-5573-41f6-ae00-3c11e8219dd4
Gosling, Tom
40b9fef0-7779-4d51-abfd-e9c2642803f2
Rees, Clare M
4a19d957-65e3-4643-b17c-ad618f74d8de
Sutcliffe, Jonathan
7255a602-ffaf-40df-a996-3d453c2a16a6
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
CASCADE study collaborators
RIFT study collaborators
Bethell, George S
c7a62cc1-5573-41f6-ae00-3c11e8219dd4
Gosling, Tom
40b9fef0-7779-4d51-abfd-e9c2642803f2
Rees, Clare M
4a19d957-65e3-4643-b17c-ad618f74d8de
Sutcliffe, Jonathan
7255a602-ffaf-40df-a996-3d453c2a16a6
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf

CASCADE study collaborators and RIFT study collaborators (2022) Impact of the COVID-19 pandemic on management and outcomes of children with appendicitis: The Children with AppendicitiS during the CoronAvirus panDEmic (CASCADE) study. Journal of Pediatric Surgery, 57 (10), 380-385. (doi:10.1016/j.jpedsurg.2022.03.029).

Record type: Article

Abstract

Aim: To report the impact of the SARS-CoV-2 pandemic on management and outcomes of paediatric appendicitis in the UK and Ireland. Methods: Prospective, multicentre observational cohort study at general surgical and specialist paediatric surgical centres in the United Kingdom and Ireland from 1st April to 31st July 2020. Primary outcome was treatment strategy used for acute appendicitis. Results: This study includes 2002 children treated for acute appendicitis of a median age of 10 (range 1–15) years and 605 children from a similar data set pre pandemic from 2017. In the pandemic cohort 560/2002(28%) were initially treated non operatively of whom 125/560(22%) proceeded to appendicectomy within initial hospital admission. Non operative treatment wasn't used in the pre pandemic cohort. Diagnostic imaging use was greater during the pandemic compared to pre pandemic (54vs31%; p < 0.00001) but overall use of laparoscopy was similar during both time periods (62.4vs66.6%). Hospital readmission rate was lower (8.7vs13.9%; p = 0.0002) during the pandemic than pre pandemic and Re-intervention rate was similar (2.9vs2.6%;p = 0.42). In cases treated operatively negative appendicectomy rate was lower during the pandemic than pre pandemic (4.4vs15.4%; p =0.0001), and during the pandemic was amongst the lowest ever reported in the UK. Conclusion: COVID-19 has had a significant impact on the management of children with appendicitis in the UK and Ireland. The rate of imaging and the use of non operative management increased, whilst the negative appendicectomy rate reduced. Overall, patient outcomes have not been adversely impacted by change in management during the pandemic. conclusion: Level I. Type of study: Prognosis study.

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Accepted/In Press date: 29 March 2022
e-pub ahead of print date: 2 April 2022
Published date: 1 October 2022
Additional Information: CASCADE study steering and writing group, George S Bethell (Southampton Children's Hospital and University of Southampton, Southampton, UK), Tom Gosling (University of Southampton, Southampton, UK), Clare M Rees (Imperial College Healthcare NHS Trust, London, UK), Jonathan Sutcliffe (Leeds Teaching Hospitals NHS Trust, Leeds, UK), Nigel J Hall (Southampton Children's Hospital and University of Southampton, Southampton, UK) Publisher Copyright: © Authors 2022
Keywords: Appendicitis, COVID-19, Negative appendicectomy, Outcomes

Identifiers

Local EPrints ID: 456499
URI: http://eprints.soton.ac.uk/id/eprint/456499
ISSN: 0022-3468
PURE UUID: 9b736474-90ad-4dea-ba41-619cd65f9071
ORCID for George S Bethell: ORCID iD orcid.org/0000-0002-1302-0735
ORCID for Nigel Hall: ORCID iD orcid.org/0000-0001-8570-9374

Catalogue record

Date deposited: 04 May 2022 16:33
Last modified: 29 Oct 2022 02:08

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Contributors

Author: George S Bethell ORCID iD
Author: Tom Gosling
Author: Clare M Rees
Author: Jonathan Sutcliffe
Author: Nigel Hall ORCID iD
Corporate Author: CASCADE study collaborators
Corporate Author: RIFT study collaborators

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