Evolving Trends in the Management of Acute Appendicitis During COVID‐19 Waves: The ACIE Appy II Study
Authors: Pata Francesco , Di Martino Marcello , Podda Mauro , Di Saverio Salomone , Ielpo Benedetto , Pellino Gianluca ,   the ACIE Appy Study Collaborative, Julio Abba , Alshamrani Abdullah , Alturkistani Abdullah , Alghamdi Abdulrahman , Almalki Abdulrahman , Orengia Adam , Kuvvetli Adnan , Pisanu Adolfo , Smith Adrian , Treviño Figueroa Adriana Michelle , Nacion Aeris Jane , Alhazmi Ahmad , Bouhuwaish Ahmad , Khalid Ahmad , Alsufyani Ahmed , Rubio Ainhoa Valle , Bavikatte Akshay , Kumar Akshay , Jamiri Al‐Radjid , de San Ildefonso Pereira Alberto , Porcu Alberto , Sartori Alberto , Rocca Aldo , Sretenovic Aleksandar , Anselmo Alessandro , De Luca Alessandro , Charalabopoulos Alexandros , Tzivanakis Alexios , Bandin Alfonso , Nájar Alfonso , Frontali Alice , Faisal Alsulaimani , Roldan Amaia Martínez , Hamid Amal , André Ana , Minaya‐Bravo Ana , Das Andre , Bondurri Andrea , Costanzi Andrea , Lucchi Andrea , Mihailescu Andrei , Police Andrea , Zuchini Andres Mendoza , Romano Angela , Iossa Angelo , Chessa Antonella , Tromba Antonella , Castaldi Antonio , Brillantino Antonio , Ferronetti Antonio , Giuliani Antonio , Ramos‐De la Medina Antonio , Tarasconi Antonio , Picciariello Arcangelo , Ioannidis Argyrios , Leppäniemi Ari , Rashid Arshad , Mitul Ashrarur Rahman , Mehraj Asif , laharwal Asim , Iqbal Atif , Liarakos Athanasios , Marinis Athanasios , de Andrés‐Asenjo Beatriz , Matías‐García Belén , De Simone Belinda , Creavin Ben , Stubbs Ben , Goh Brian , Jovanovic Branislav , Sensi Bruno , Gazia Carlo , Cerdán Carlos , Díaz Carlos Javier Gómez , Chacón Carlos Petrola , Yánez Carlos , Faro Carmelo Lo , Reinke Caroline , Dominguez Casandra , Paranjape Charudutt , Thomas Charlotte , Fung Chia Chi , De Lucia Chiara , Jennifer Chiu Hiu Fung , Ovalle‐Chao Christian , Guerci Claudio , Kenington Cleo , Gica Corina , Folliero Cristina , Varela Cristopher , Popowich Daniel , Delogu Daniele , Zigiotto Daniele , Vinci Danilo , D'Antonio Dario , Merlini David Alessio , Merlini David , Moro‐Valdezate David , Keller Deborah , Nicolaescu Diana Cristiana , Sasia Diego , Rodas Edgar , Linardoutsos Dimitrios , Russello Domenico , Nájar‐Castañeda Pedro Alfonso , Stavrou Habil Gregor , Rosso Edoardo , Saladino Edoardo , Ricciardi Edoardo , Smith‐Singares Eduardo , Baili Efstratia , Douka Eleftheria , Guaitoli Eleonora , Francone Elisa , Vaterlini Elisa Maria , Pierobon Elisa Sefora , Morales Emilio , Ros Emilio Peña , Benzoni Enrico , Erdas Enrico , Pinotti Enrico , Colás‐Ruiz Enrique , Laterza Ernesto , Foianini Esteban , Cardamone Eugenia , Licardie Eugenio , Marino Fabio , Alsofyani Fahad , Qahtani Fahad , Khan Farhan , Maraska Fatlum , Saliu Fatmir , Madrid Fausto , Rosa Fausto , Luvisetto Federico , Alconchel Felipe , Pareja‐Ciuro Felipe , Neves Fernanda , Agresta Ferdinando , Cordera Fernando , Pardo Fernando , Mendoza‐Moreno Fernando , Munoz‐Flores Fernando , Silvestri Francesca Maria , Tropeano Francesca Paola , Pecchini Francesca , Serio Francesca , Colombo Francesco , Di Marzo Francesco , Ferrara Francesco , Lancellotti Francesco , Litta Francesco , Martini Francesco , Roscio Francesco , Blanco‐Antona Francisco , Barcenas Francisco Javier Quezada , Schlottmann Francisco , Herrera‐Almario Gabriel , van Ramshorst Gabrielle , Gallo Gaetano , Luglio Gaetano , Kampouroglou Georgios , Papadopoulos Georgios , Arredondo Gerardo , Calini Giacomo , Formisano Giampaolo , Galiffa Giampaolo , Palini Gian Marco , Colucci Gianluca , Pagano Gianluca , Vanni Gianluca , Pattacini Gianmaria Casoni , Gravante Gianpiero , Lisi Giorgio , Bellanova Giovanni , De Nobili Giovanni , Necchi Giovanni Sammy , Sinibaldi Giovanni , Bacchiocchi Giulia , Bagaglini Giulia , Maggi Giulia , Izzo Giuliano , Argenio Giulio , Brisinda Giuseppe , Esposito Giuseppe , Frazzetta Giuseppe , De Luca Giuseppe Massimiliano , Nigri Giuseppe , Sica Giuseppe , Martin‐Martin Gonzalo , Ugon Gustavo Armand , Martinez‐Mier Gustavo , Machain Vega Gustavo Miguel , Nari Gustavo , Nikaj Herald , Neri Ignacio , San Roman Igor Alberdi , Fidoshev Iliya , Martínez Iñaki , Negoi Ionut , Ortega Irene , Vicente Rodríguez Irune , Cornejo Isabel , Mora‐Guzmán Ismael , al‐Najami Issam , Romic Ivan , Balciscueta Izaskun , Olivier James , Lammel‐Lindemann Jan , Dziakova Jana , Salinas Javier , Jovanovic Jelena Pejanovic , Reyes Jeryl Anne Silvia , Salas Joanne , Diaz‐Elizondo Jose Antonio , Parreira Jose Gustavo , Bellido Juan , Salamea Juan , Martín del Olmo Juan Carlos , Ordoñez Juliana María , Junaid Sofi , Davies Justin , Sahnan Kapil , Bekele Kebebe , Voon Kelvin , Siragusa Leandro , Petagna Lorenzo , Ferrario Luca , Giordano Luca , Nespoli Luca , Pio Luca , Moletta Lucia , Curella Luciano , Taglietti Lucio , Bonavina Luigi , Conti Luigi , Pérez‐Sánchez Luis Eduardo , Cabrera Vargas Luis Felipe , Sánchez‐Guillén Luis , Tallon‐Aguilar Luis , Khan Mansoor , Spampinato Marcello Giuseppe , Viola Marcelo , Malet Marcelo Viola , Angrisani Marco , Calussi Marco , Catarci Marco , Giordano Marco , Materazzo Marco , Milone Marco , Pellicciaro Marco , Marino Marco Vito , Moreno Villamizar María Daniela , Lolli Maria Giulia , Bellini Maria Irene , Lemma Maria , Chiarello Maria Michela , Montes‐Manrique Mario , Rodriguez‐Lopez Mario , Serradilla‐Martín Mario , Peter Mark , Paniagua‐García‐Señoráns Marta , Rutegård Martin , Salö Martin , Silveri Massimiliano , Veroux Massimiliano , Nardi Matteo , Rottoli Matteo , Tolonen Matti , Pedraza Ciro Mauricio , Zuluaga Mauricio , Iacobone Maurizio , Montuori Mauro , Ali Mazin , García Domínguez Melody , Paola Menna Maria , Piccoli Micaela , Campanelli Michela , De Rosa Michele , Manigrasso Michele , Maruccia Michele , Torre Michele , Zuolo Michele , Pera Miguel , Weerasekera Mihiri , Prieto Mikel , Thway Min Myat , Shaat Mohamed , Azfar Mohammad , Shalaby Mostafa , Raza Muhammad Asif , Younis Muhammad Umar , Elhadi Muhammed , Ali Mujahid , AlThomali Musab , Al Amri Nadiah , Dudi‐Venkata Nagendra , Alselaim Nahar , Smart Neil , Trelles Nelson , Falco Nicolò , Petrucciani Niccolo , Antonacci Nicola , Cillara Nicola , Gica Nicolae , Pecorelli Nicolò , Tamini Nicolò , Machairas Nikolaos , Feituri Nura , Ortega Torrecilla Nuria , Avila Mercado Octavio , AlAamer Ohood , Irkorucu Oktay , Alsherif Omar , Buonomo Oreste Claudio , Valles‐Guerra Orestes , Ioannidis Orestis , Hernández Palmas Oscar Isaac , Sanz Guadarrama Oscar , Bozbiyik Osman , Rodrigues Pablo , Milito Pamela , Panaccio Paolo , Dorovinis Panagiotis , Prieto Paola , Baroffio Paolo , Marsanic Patrizia , Ajawin Pawel , Koh Peng Soon , Anoldo Pietro , Major Piotr , Alharthi Qasem , Lui Rashid , Caruso Riccardo , Brady Richard , Rattan Rishi , Singhal Rishi , Angelico Roberta , Isernia Roberta Maria , Tutino Roberta , Peltrini Roberto , Tejos Rodrigo , Fajardo Roosevelt , Elia Rossella , Morales‐Conde Salvador , Benli Sami , Fuentes Sara , de las Casas Sara Gortázar , de Guzmán Aragón Sara Ortiz , Vertaldi Sara , Awad Selmy , Gentilli Sergio , Weckmann Lujan Sergio Alberto , Tayar Serkan , Althobaiti Shabab , Di Giovanni Silvia , Ghedan Soliman , Pérez‐Bertólez Sonia , Chiappetta Sonja , Delis Spiros , Scaringi Stefano , Çetinkünar Süleyman , Kykalos Stylianos , Muhammad Ali Syed , Krivan Sylvia , Fung Tak Lit Derek , Delko Tarik , Nicolás López Tatiana , De Campos Tercio , Calderón Duque Teresa , Perra Teresa , Liakakos Theodore , Daskalakis Theodoros , Koëter Tijmen , Zalla Tiku , González Tomás Elosua , Campagnaro Tommaso , Oumar Toure Alpha , Grossi Ugo , Sosa Valentina , Testa Valentina , Tomajer Valentina , Andriola Valeria , Tonini Valeria , Celentano Valerio , Voglino Valerio , Katta Venkateswara Rao , García Orozco Víctor Hugo , Turrado‐Rodriguez Victor , Visag‐Castillo Victor , Graham Victoria , Rachkov Viktor , Papagni Vincenzo , Vigorita Vincenzo , Jiménez Carneros Virginia , Bellato Vittoria , Bechstein Wolf , Altinel Yuksel , Balciscueta Zutoia 
Published: July 2022

Background

In 2020, ACIE Appy study showed that COVID‐19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non‐operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak.

Methods

From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS‐CoV‐2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study.

Results

A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM.

Conclusion

Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS‐COV‐2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide.