Impact of SARS-Cov2 Pandemic on Severity of Perioperative Complications in Patients Undergoing Appendectomy

Study Overview
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Brief Summary
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There are 2 types of surgical procedures to remove the appendix : open appendectomy or laparoscopic appendectomy. About 60000 appendectomies are performed every year in France. Early diagnosis of acute appendicitis is essential to prevent the risk of disease progression, leading to complicated appendicitis and an increased risk for mortality. Data regarding appendicitis management in the literature are numerous. However, the impact of COVID-19 pandemic on the management of those patients has led to a decrease in the number of visits for acute appendicitis (ER), but a higher proportion of complicated appendicitis, probably due to the patient's delayed decision to go to emergency department at the onset of clinical symptoms. Complicated appendicitis may also lead to an overuse of antibiotics, a longer hospital stay, and a higher global cost for the health system. This aim of this study was to evaluate whether this hypothesis was valid for the regional NANCY-METZ area (CHR Metz and CHRU Nancy). The main research hypothesis was that the pandemic caused by SARS-COVID 19 was significantly linked to an increased incidence of perioperative complications in patients who underwent an appendectomy for acute appendicitis in this region (North-east part of France).

Detailed Description
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Appendix is a finger-like, blind-ended tube connected to the cecum. The most frequent disease regarding the appendix is appendicitis. Appendicitis is an inflammation of the appendix caused by an obstruction of the lumen of the appendix. This obstruction is most commonly due to an appendicolith (calcified stone made of feces). Inflamed lymphoid tissue from a viral infection, parasites, gallstone, or tumors may also cause the blockage. This blockage leads to an increased pressure in the appendix, leading to a decreased blood flow to the tissues of the appendix, and bacterial growth inside the appendix causing inflammation. The combination of inflammation, reduced blood flow to the appendix and distention of the appendix causes tissue injury and lead to infection and potentially necrosis. If this process is left untreated, the appendix may burst, releasing bacteria into the abdominal cavity, leading to a peritonitis with a potential impact on mortality rate. Appendicitis symptoms include right lower abdominal pain, nausea, vomiting, and decreased appetite. Complicated appendicitis is defined as perforated appendicitis, peri-appendicular abscess or peritonitis. Consequently, acute appendicitis is considered to be a surgical emergency. There are 2 types of surgical procedures to remove the appendix : open appendectomy or laparoscopic appendectomy. About 60000 appendectomies are performed every year in France. Early diagnosis of acute appendicitis is essential to prevent the risk of disease progression, leading to complicated appendicitis and an increased risk for mortality. Data regarding appendicitis management in the literature are numerous. However, the impact of COVID-19 pandemic on the management of those patients has led to a decrease in the number of visits for acute appendicitis (ER), but a higher proportion of complicated appendicitis, probably due to the patient's delayed decision to go to emergency department at the onset of clinical symptoms. Complicated appendicitis may also lead to an overuse of antibiotics, a longer hospital stay, and a higher global cost for the health system. This aim of this study was to evaluate whether this hypothesis was valid for the regional NANCY-METZ area (CHR Metz and CHRU Nancy). The main research hypothesis was that the pandemic caused by SARS-COVID 19 was significantly linked to an increased incidence of perioperative complications in patients who underwent an appendectomy for acute appendicitis in this region (North-east part of France).

Official Title
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Impact of SARS-Cov2 Pandemic on Severity of Perioperative Complications in Patients Undergoing Appendectomy

Conditions
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Postoperative Complications, Appendicitis, COVID-19 Pandemic, Appendicitis With Peritonitis

Intervention / Treatment
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* Procedure: appendectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients who underwent appendectomy Exclusion Criteria: pregnancy protection of vulnerable adults disability

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control group without Covid 19 pandemic<br>- Patients who underwent an appendectomy from March 17, 2018 to December 14, 2018 and from March 17, 2019 to December 14, 2019 | Procedure: appendectomy<br>* appendectomy for acute appendicitis<br>|
| Test group with Covid 19 pandemic<br>- Patients who underwent an appendectomy from March 17, 2020 to December 14, 2020 | Procedure: appendectomy<br>* appendectomy for acute appendicitis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perioperative complications after appendectomy | validated classification (Gomes classification) | from March 17 to December 14 (2020-2021 versus 2019-2018) | 
| Postoperative complications after appendectomy | validated classification (Clavien Dindo classification) | from March 17 to December 14 (2020-2021 versus 2019-2018) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Delay before surgery | Time duration from Symptoms onset and appendectomy | from March 17 to December 14 (2020-2021 versus 2019-2018) | 
| Hospitalization duration | Hospitalization duration | from March 17 to December 14 (2020-2021 versus 2019-2018) | 
| Antibiotherapy duration | Total antibiotherapy duration | from March 17 to December 14 (2020-2021 versus 2019-2018) | 
| Biological inflammatory syndrom | Hyperleucocytosis > 10000/mm3 and/or PCR > 100 mg/L | from March 17 to December 14 (2020-2021 versus 2019-2018) | 
| Type of hospitalisation | ward / ICU | from March 17 to December 14 (2020-2021 versus 2019-2018) | 
| Delay between appedectomy and postoperative complications | < 7 days; 7-30 days; > 30 days | from March 17 to December 14 (2020-2021 versus 2019-2018) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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appendectomy, postoperative complications, covid 19