Influência da pandemia de COVID-19 na apresentação da apendicite aguda e nos resultados cirúrgicos em hospital público de Salvador, Bahia

Influence of the COVID-19 pandemic on the presentation of acute appendicitis and surgical outcomes in a public hospital in Salvador, Brazil

Abstract

Introduction: In the first months of the COVID-19 pandemic, patients with acute appendicitis (AA) found the health system overloaded, pressured by adaptations, which could compromise the results of surgical treatment. For example, the admission of patients with longer disease progression and greater use of open appendectomies. Objective – to compare the frequency, severity, and outcomes of laparoscopic and open appendectomies in a public referral hospital in the city of Salvador, state of Bahia, in the transpandemic period of COVID-19 with the pre-pandemic period.  Methodology – retrospective study with two series of patients who underwent appendectomy at the Municipal Hospital of Salvador (HMS), between March 1, 2019 and February 28, 2020 (pre-pandemic) and from March 1, 2020 to February 28, 2021 (first transpandemic year). The analysis included the time of symptom progression, the classification of AA by severity, as well as the types of interventions and outcomes.  Results – data from 882 patients of AA appendectomies at HMS were analyzed: 470 cases in the previous year (pre-pandemic) and 412 in the transpandemic. Of the total, 490 (55.6%) laparoscopic appendectomies and 392 (44.4%) open appendectomies: in the pre-pandemic, there were 307 (65.3%) laparoscopic appendectomies, another 20 (6.0%) converted, completing 163 (34.7%) open appendectomies. In the first transpandemic year, 185 (44.9%) laparoscopic appendectomies were performed, another 10 (5.1%) converted, comprising 227 (55.1%) open appendectomies. Postoperative complication rates were 38.5% with open surgery and 15.7% with laparoscopic surgery. Reoperations were more frequent in open surgery (11.0% versus 5.5%), as well as operative mortality (2.1% versus 0.4%). The length of hospital stay was longer in cases of open appendectomy, especially in the elderly and children.  Conclusion – The impact of the COVID-19 pandemic produced significant changes in the time of symptom evolution and surgical treatment of AA and were related to greater severity, reoperation rates, hospital stay times, and postoperative complications, related to the increase in the number of open appendectomies.