COVİD-19 PANDEMİ DÖNEMİNDE AKUT APANDİSİT Mİ, NEGATİF APENDEKTOMİ Mİ AZALDI?

Abstract

Amaç Pandemi döneminde hastanelerden duyulan korku ve kısıtlamalar acil serviste hasta başvurularını önemli ölçüde azaltırken çeşitli cerrahi hastalıkların ciddiyetinde kayda değer bir artışına neden olmuştur. Çalışmamızda ameliyat edilen akut apandisit olgularının başvuru anındaki hastalık ciddiyetini ve negatif apendektomi oranlarını belirleyerek bu sonuçları pandemi olmayan dönemle karşılaştırmayı amaçladık. Gereç ve Yöntem Pandemi döneminde (12.03.2020- 31.05.2020) ve pandemi olmayan dönemde (12.03.2019-31.05.2019) apandisit nedeniyle tedavi edilen 152 hastanın verileri geriye dönük olarak incelendi. Apendektomi sayıları, komplike akut apandisit oranları, apandiks çapları, inflamatuar belirteçler, tanısal amaçla tercih edilen görüntüleme yöntemleri ve hastaların hastanede yatış süreleri ile ilgili veriler analiz edildi. Bulgular Pandemi döneminde bir önceki yılın aynı zaman aralığına kıyasla apendektomi sayısının %41,6 oranında azaldığı tespit edildi. Pandemi döneminde lökosit ve nötrofil sayısı ve apendiks çapının pandemi olmayan döneme göre anlamlı oranda arttığı izlendi (sırasıyla p=0.003,p=0.014,p=0,013). Her iki dönemde hastanede yatış süreleri açısından anlamlı farklılık izlenmedi. Pandemi döneminde anlamlı oranda olmasada bilgisayarlı tomografi kullanımının arttığı (%59,3’e karşı %73,3) ve USG kullanımının azaldığı (%40,7’ye karşı %26,7) tespit edildi. Komplike olmayan akut apandisit ve malignite oranlarının her iki dönemde benzer olduğu izlendi (sırasıyla %63,5, %67,9 ve %2,1, %1,8). Pandemi döneminde anlamlı oranda olmamakla birlikte komplike apandisit oranının arttığı (%16,7’ye karşı %23,2) ve negatif apendektomi oranının azaldığı (%17,7’ye karşı %7,1) izlendi. Sonuç Pandemi öncesi dönemle kıyaslandığında komplike apandisit ve negatif apendektomi oranlarında tespit ettiğimiz ancak istatistiksel olmayan farkla ilgili mevcut literatürden kesin hüküm çıkarmak mümkün değildir. Pandemi apandisitin tanı zamanının yanı sıra seyrini ve tedavi yaklaşımını de etkilemiştir.

Keywords

• COVİD-19
• akut apandisit
• negatif apendektomi

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ACUTE APPENDICITIS OR NEGATIVE APPENDECTOMY? WHICH WAS REDUCED DURING THE COVID-19 PANDEMIC?

Abstract

Objective The restrictions and fear against the hospitals during the pandemic has caused a reduction in the emergency department admittance but it appears that patients with various surgical conditions have admitted with an advanced condition. The aim of the present study is to evaluate and to compare disease severity at the time of admittance and the negative appendectomy rates among the patients who were operated for acute appendicitis between the pandemic period and before the pandemics. Material and Method The data of the 152 patients who were operated for acute appendicitis during the first episode of restrictions of the pandemics (03.12.2020-05.31.2020) and 1 year before the restrictions (03.12.2019-05.31.2019) were retrospectively evaluated. The rates of appendectomy and complicated appendicitis, appendiceal diameter, inflammatory markers, diagnostic imaging modalities and length of hospital stay were evaluated. Results The appendectomy rates were reduced in the pandemic period by 41.6% compared to the previous period. Leucocyste and neutrophile counts and appendiceal diameter were significantly higher in the pandemic period than the previous period (p=0.003, p=0.014, p=0.013, respectively). No significant difference was observed for length of hospital stay between the 2 periods. Although not statistically significant, CT was more commonly performed (59.3% vs 73.3%) while US was less commonly performed (40.7% vs. 26.7%) in the pandemic period. The rates of non-complicated appendicits and malignancy were not different between the 2 periods (63.5% vs. 67.9% and 2.1% vs. 2.8%, respectively). Although not statistically significant, the rate of complicated appendicitis was increased (16.7% vs. 23.2%) and the rate of negative appendicitis was reduced (17.7% vs. 7.1%) Conclusion It is not possible to withdraw strong conclusions depending on the current literature data regarding the prepandemic and pandemic comparison of complicated appendicitis and negative appendicitis. Pandemic has caused a considerable impact on the appendicitis severity at admission and management process.

Keywords

• acute appendicitis
• negative appendectomy
• COVID-19

Project Number

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References

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