Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19∙8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6∙6 and 2∙4 per cent respectively before, but 23∙7 and 5∙3 per cent, during the pandemic (both P < 0∙001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2.

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE appy study / Ielpo, Benedetto; Podda, Mauro; Pellino, Gianluca; Pata, Francesco; Gravante, Gianpiero; Di Saverio, Salomone; Gallo, Gaetano; Lui, Rashid; Orengia, Adam; Chowdary, Aditya; Kulkarni, Aditya; Kuvvetli, Adnan; Navarro, Adolfo; Pisanu, Adolfo; Smith, Adrian; Cavero Ibiricu, Adriana; D Nacion, Aeris Jane; Alsaleh, Ahmad; Alhazmi, Ahmad; Elmabri, Ahmad; Wani, Ajaz; Rencuzogullari, Ahmet; Sarriugarte Lasarte, Aingeru; Valle Rubio, Ainhoa; Bavikatte, Akshay; Kumar, Akshay; Jamiri, Al-Radjid; Michel Alvarado Padilla, Alain; Cacurri, Alban; de San Ildefonso, Alberto; Porcu, Alberto; Sartori, Alberto; Rocca, Aldo; Paz Yáñez, Alejandro; Becaria, Alejandro; Solís-Peña, Alejandro; Sretenović, Aleksandar; Urbistondo, Alex; Bandin, Alfonso; Najar, Alfonso; De Luca, Alessandro; Boddy, Alex; Charalabopoulos, Alexandros; Tzivanakis, Alexios; Amendola, Alfonso; Ramirez-Gutierrez de Velasco, Alfredo; Cihat Yildirim, Ali; Frontali, Alice; Oumar Toure, Alpha; García-Granero, Alvaro; Martínez Roldan, Amaia; Sanz Larrainzar, Amaia; Sanjiva Ratnayake, Amila; María Gonzalez-Ganso, Ana; M Minaya-Bravo, Ana; Das, Andre; Bondurri, Andrea; Costanzi, Andrea; Lucchi, Andrea; Mazzari, Andrea; Musig, Andrea; Peloso, Andrea; Piano, Andrea; Police, Andrea; Mihailescu, Andrei; Pouy, Andrés; Romano, Angela; Iossa, Angelo; Carmen Leonetti, Anna; Guariniello, Anna; Isaac, Anna; Pia Delli Bovi, Anna; Chessa, Antonella; Tromba, Antonella; Álvarez Martínez, Antonio; Brillantino, Antonio; Caira, Antonio; Castaldi, Antonio; Ferronetti, Antonio; Giuliani, Antonio; Prestera, Antonio; Ramos-De la Medina, Antonio; Tarasconi, Antonio; Tornambè, Antonino; Picciariello, Arcangelo; Ioannidis, Argyrios; Leppäniemi, Ari; Khan, Arshad; Rashid, Arshad; Luis Eduardo Pérez-Sánchez, Arteaga; Mittal, Ashok; Rahman Mitul, Ashrarur; Mehraj, Asif; Laharwal, Asim; Dorismé, Asnel; Marinis, Athanasios; Iqbal, Atif; Moncada, Augusto; Braccio, Bartolomeo; Alkhafaji, Basim; de Andrés Asenjo, Beatriz; Martin-Perez, Beatriz; Sánchez Pérez, Belinda; Creavin, Ben; Calì, Benedetto; Pascotto, Beniamino; Stubbs, Benjamin; Zavala Retes, Benjamin; Jovanovic, Branislav; Kp Goh, Brian; Sensi, Bruno; Biddau, Carlo; Gazia, Carlo; Vallicelli, Carlo; Alberto Fagundes, Carlos; Cerdán Santacruz, Carlos; Chirico, Carlos; Javier Gómez, Carlos; Petrola, Carlos; Sánchez Rodriguez, Carlos; Yánez Benítez, Carlos; Dammaro, Carmelisa; Lo Faro, Carmelo; Reinke, Caroline; Dominguez Paez, Casandra; Oliva, Catalina; Paranjape, Charudutt; Thomas, Charlotte; Fung Chia, Chi; Kwan Kong, Chi; De Lucia, Chiara; Ovalle Chao, Christian; Arcudi, Claudio; Guerci, Claudio; Chia, Clement; Parise, Cristiano; Folliero, Cristina; Varela, Cristopher; M Ferguson, Dalya; Camacho, Daniel; Popowich, Daniel; Souza Lima, Daniel; Rega, Daniela; Delogu, Daniele; Zigiotto, Daniele; Vinci, Danilo; D'Antonio, Dario; Parini, Dario; Alessio Merlini, David; DE Zimmerman, David; Moro-Valdezate, David; Pertile, Davide; Maria Giusti, Deborah; S Keller, Deborah; Tarik, Delko; Kalivaçi, Denis; Mazingi, Dennis; Gabriela Maldonado-Pintado, Diana; Sasia, Diego; Linardoutsos, Dimitrios; Osilli, Dixon; Murrone, Domenico; Russello, Domenico; Rodas, Edgar; Alberto Acuña Roa, Edisson; Ricciardi, Edoardo; Rosso, Edoardo; Saladino, Edoardo; Flores-Villalba, Eduardo; Ruiz Ajs, Eduardo; Smith-Singares, Eduardo; Baili, Efstratia; Kouroumpas, Efstratios; Bourmpouteli, Eirini; Douka, Eleftheria; Martin-Perez, Elena; Guaitoli, Eleonora; Samadov, Elgun; Francone, Elisa; Vaterlini, Elisa; Morales, Emilio; Peña, Emilio; Zhao, Enhao; Del Pozo Andres, Eneko; Benzoni, Enrico; Erdas, Enrico; Pinotti, Enrico; Colás-Ruiz, Enrique; Aytac, Erman; Laterza, Ernesto; Agastra, Ervis; Foianini, Esteban; Moscoso, Esteban; Laviano, Estefania; Marra, Ester; Cardamone, Eugenia; Licardie, Eugenio; Mpaili, Eustratia; Pinna, Eva; Varo, Evaristo; Martín Navarro, Fabian; Marino, Fabio; Medas, Fabio; Romano, Fabio; Maraska, Fatlum; Saliu, Fatmir; Madrid, Fausto; Rosa, Fausto; Mastella, Federica; Gheza, Federico; Luvisetto, Federico; Alconchel, Felipe; Monge Vieira, Felipe; Pareja, Felipe; Agresta, Ferdinando; Luna, Fernanda; Bonilla, Fernando; Cordera, Fernando; Burdió, Fernando; Mendoza-Moreno, Fernando; Muñoz Flores, Fernando; Pardo Aranda, Fernando; Taylor, Fiona; L Ramos, Flavia; Fernandes, Flavio; Paola Tropeano, Francesca; Balestra, Francesco; Bianco, Francesco; Ceci, Francesco; Colombo, Francesco; Di Marzo, Francesco; Ferrara, Francesco; Lancellotti, Francesco; Lazzarin, Francesco; Litta, Francesco; Martini, Francesco; Pizza, Francesco; Roscio, Francesco; Virdis, Francesco; Blanco Antona, Francisco; Cervantes Ramírez, Francisco; Miguel Fernandez, Francisco; Oliver Llinares, Francisco; Quezada, Francisco; Schlottmann, Francisco; Herrera-Almario, Gabriel; Massaferro, Gabriel; Bislenghi, Gabriele; van Ramshorst, Gabrielle; Gallo, Gaetano; Luglio, Gaetano; Bointas, Georgios; Kampouroglou, Georgios; Papadopoulos, Georgios; Arredondo Manrique, Gerardo; Calini, Giacomo; Nastri, Giacomo; Formisano, Giampaolo; Galiffa, Giampaolo; Marco Palini, Gian; Colucci, Gianluca; Pagano, Gianluca; Pellino, Gianluca; Vanni, Gianluca; Casoni Pattacini, Gianmaria; Gravante, Gianpiero; De Paola, Gilda; Lisi, Giorgio; Partida, Giovanna; Bellanova, Giovanni; De Nobili, Giovanni; Sammy Necchi, Giovanni; Sinibaldi, Giovanni; Tebala, Giovanni; Bagaglini, Giulia; Izzo, Giuliano; Argenio, Giulio; Brisinda, Giuseppe; Candilio, Giuseppe; Di Grezia, Giuseppe; Esposito, Giuseppe; Faillace, Giuseppe; Frazzetta, Giuseppe; La Gumina, Giuseppe; Nigri, Giuseppe; Romeo, Giuseppe; Chocarro Amatriaín, Gloria; Ortega, Gloria; Martin-Martin, Gonzalo; A Stavrou, Gregor; Gunadi, ; Armand Ugon, Gustavo; Machain, Gustavo; Marcucci, Gustavo; Martínez-Mier, Gustavo; Miguel Machain, Gustavo; Nari, Gustavo; Calvo, Haydée; Fathy, Hamada; Hamilto, ; Ahmed, Hazem; Faraj, Hazem; Nava, Hector; Ordas Macias, Hector; Nikaj, Herald; Solano, Heriberto; Ahmed Khan, Huma; Sánchez Alarcón, Humberto; Ebied, Husam; Giani, Iacopo; Villalabeitia Ateca, Ibabe; Neri, Ignacio; Alberdi San Roman, Igor; Fidoshev, Iliya; Martinez Rodriguez, Iñaki; Negoi, Ionut; Ortega, Irene; Bernescu, Irina; Shari Russo, Iris; Vincente Rodríguez, Irune; Palomares, Irving; Baltazar, Isaac; Jaén Torrejimeno, Isabel; María Cornejo Jurado, Isabel; Reccia, Isabella; Hussain, Ishtiyaq; Brito Toledo, Ismael; Mora-Guzmán, Ismael; Dogaru, Iulia; Romic, Ivan; Balciscueta, Izaskun; Cleo Kenington, J; Sagolsem, Jackison; Y Jang, Jae; Olivier, James; Lammel-Lindemann, Jan; Dziakova, Jana; Ismael Roldán Villavicencio, Javier; Salinas, Javier; Pejanovic, Jelena; Gustavo Parreira, Jose; Jovanovic, ; Rincón Pérez, Jeny; AsReyes, Jeryl; Antonio Medina Luque, Jesus; Mak, Joanna; Salas Rodriguez, Joanne; Henry Herrera Kok, Johnn; Krook, Jon; Antonio Diaz-Elizondo, Jose; Castell, Jose; Eduardo García-Flores, José; María Jover Navalón, José; Mauro Silva Rodrigues, Jose; Pereira, José; Tomas Castell Gómez, José; Bellido Luque, Juan; Carlos Martín Del Olmo, Juan; Carlos Salamea, Juan; Francisco Coronel Olivier, Juan; Luis Blas Laina, Juan; Maria Ordoñez, Juliana; Gutierrez, Julieta; Abba, Julio; Ahmad Sofi, Junaid; Sherafgan, Kashaf; Sahnan, Kapil; Yanaga, Katsuhiko; Beatson, Kevin; Asim, Laharwal; Alvarez, Laura; Siragusa, Leandro; Farber, Lee; Ong, Lester; Athanasios, Liarakos; García-Bruña, Lorena; De Martino, Luca; Ferrario, Luca; Giordano, Luca; Gordini, Luca; Pio, Luca; Ponchietti, Luca; Moletta, Lucia; Curella, Luciano; Poggi, Luciano; Taglietti, Lucio; Bonavina, Luigi; Conti, Luigi; Goffredi, Luigi; Angel Garcia Ruiz, Luis; Barrionuevo, Luis; Enrique Fregoso, Luis; F Cabrera, Luis; G Rodriguez, Luis; Grande, Luis; Gregorio Osoria, Luis; Javier Kantun Gonzalez, Luis; Sánchez-Guillén, Luis; Tallon-Aguilar, Luis; Tresierra, Luis; Giavarini, Luisa; Hasabelnabi, Mahmoud; Odovic, Maja; Uemura, Mamoru; Khan, Mansoor; Artiles-Armas, Manuel; David, Mara; Di Martino, Marcello; Giuseppe Spampinato, Marcello; F Ribeiro, Marcelo A; Viola, Marcelo; Angrisani, Marco; Calussi, Marco; Cannistrà, Marco; Catarci, Marco; Cereda, Marco; Conte, Marco; Giordano, Marco; Pellicciaro, Marco; Vito Marino, Marco; E Vaterlini, Maria; F Jiménez, María; Giulia Lolli, María; Bellini, Maria Irene; Lemma, Maria; Michela Chiarello, Maria; Nicola, Maria; Arrigo, Mario; Caneda Mejia, Mario; Montes Manrique, Mario; Rodriguez-Lopez, Mario; Serradilla-Martín, Mario; Zambrano Lara, Mario; Martínez, Marisa; Bagnall, Mark; Peter, Mark; Cañón Lara, Marta; Jimenez Gomez, Marta; Paniagua-Garcia-Señorans, Marta; Perez Gonzalez, Marta; Rutegård, Martin; Salö, Martin; Franceschilli, Marzia; Silveri, Massimiliano; Veroux, Massimiliano; Pezzulo, Massimo; Nardi, Matteo; Rottoli, Matteo; Tolonen, Matti; Pedraza Ciro, Mauricio; Zuluagua, Mauricio; Cannavò, Maurizio; Cervellera, Maurizio; Iacobone, Maurizio; Montuori, Mauro; Podda, Mauro; García Domínguez, Melody; Bingol-Kologlu, Meltem; Tahir, Mian; Lim, Michael; Sj Wilson, Michael; Wilson, Michael; Campanelli, Michela; Bisaccia, Michele; De Rosa, Michele; Maruccia, Michele; Paterno, Michele; Pisano, Michele; Torre, Michele; Treviño, Michele; Zuolo, Michele; A Hernandez Bartolome, Miguel; Farina, Miguel; Pera, Miguel; Prieto Calvo, Miguel; Sotelo, Milagros; Myat Thway, Min; Hassan, Mohamed; Salah Eldin Hassan, Mohamed; Azfar, Mohammad; Bouhuwaish, Mohammad; Taha, Mohammad; Zaieem, Mohammad; Korkoman, Mohammed; Guraieb, Montserrat; Shalaby, Mostafa; Asif Raza, Muhammad; Umar Younis, Muhammad; Elhadi, Muhammed; Zulfiqar Ali, Mujahid; Quazi, Nadeem; N Dudi-Venkata, Nagendra; Alselaim, Nahar; Loria, Natasha; Villan Ramírez, Nathalie; Win Than, Nay; Smart, Neil; Trelles, Nelson; Pinto, Nicanor; Allievi, Niccolò; Petrucciani, Niccolo; Antonacci, Nicola; Cillara, Nicola; Gica, Nicolae; Diana Cristiana, Nicolaescu; Nicolás, Nicolás; Falco, Nicolò; Pecorelli, Nicolò; Tamini, Nicolò; Andreas Dallas, Nikolaos; Machairas, Nikolaos; Brito, Noelia; Ahmed Fieturi, Nura; Ortega, Nuria; AvilaMercado, Octavio; Irkorucu, Oktay; Alsherif, Omar; Valles, Orestes; Ioannidis, Orestis; Hernández Palmas, Oscar; Isaac Hernandez Palmas, Oscar; Sanz Guadarrama, Oscar; Bozbiyik, Osman; Omelanczuk, Pablo; Ottolino, Pablo; Rodrigues, Pablo; Ruiz, Pablo; Campenni, Paola; Chiarade, Paola; Prieto Olivares, Paola; Baroffio, Paolo; Baroffio, Paolo; Wintringer, Pascal; Di Fronzo, Pasquale; Talento, Pasquale; Favoriti, Pasqualino; Sendino, Patricia; Marsanic, Patrizia; Mifsut, Patricia; Andrade, Paúl; Ajawin, Pawel; Ferri, Valentina; Massimiliano de Luca, Giuseppe; Ingallinella, Sara; Pueyo, Eva; Palmieri, Francesco; Silva, Jesus; Min Chin, Ken; Syn, Nicholas; P Goh, Brian K; Xin Koh, Ye; Tonini, Valeria; Gonzales-Ganso, Ana; Simó, Vicente; Victoria Diago, Maria; Abadía-Barnó, Pedro; Alfonso Najar Castañeda, Pedro; Omar Sillas Arevalos, Pedro; Palazón Bellver, Pedro; Soon Koh, Peng; Souza, Petry; Major, Piotr; Singh Bali, Rajandeep; Mohan Khattar, Rakesh; Bessa Melo, Renato; Ebrahiminia, Reza; Azar, Ricardo; López Murga, Ricardo; Caruso, Riccardo; Pirolo, Riccardo; Brady, Richard; Justin Davies, Richard; Dholakia, Rishi; Rattan, Rishi; Singhal, Rishi; Lim, Robert; Angelico, Roberta; Maria Isernia, Roberta; Tutino, Roberta; Faccincani, Roberto; Peltrini, Roberto; Carrera-Ceron, Rocío; Tejos, Rodrigo; Kashyap, Rohit; Fajardo, Roosevelt; Lozito, Rosa; Madariaga Pareja, Royer; Garbarino, Sabrina; Di Saverio, Salomone; Morales-Conde, Salvador; Benli, Sami; Mansour, Sami; Flores, Samir; Limon Suarez, Samuel; Lopez Ben, Santiago; Fuentes, Sara; Napetti, Sara; Ortiz de Guzmán, Sara; Awad, Selmy; A Weckmann Luján, Sergio; Gentilli, Sergio; Grimaldi, Sergio; Olivares Pizarro, Sergio; Tayar, Serkan; Nabi, Shakeeb; M Chan, Shannon; Junaid, Sheikh; Rojas, Sidney; Monetti, Silvana; García, Silvia; Salvans, Silvia; Tenconi, Silvia; Shaw, Simon; Santoni, Simone; Andrea Parra, Sofia; Cárdenas, Sofía; Pérez-Bertólez, Sonia; Chiappetta, Sonja; Dessureault, Sophie; Delis, Spiros; Amore Bonapasta, Stefano; Rausei, Stefano; Scaringi, Stefano; Keswani, Sundeep; Muhammad Ali, Syed; Cetinkunar, Süleyman; Lit Derek Fung, Tak; Rawashdeh, Tariq; Nicolás López, Tatiana; De Campos, Tercio; Calderon Duque, Teresa; Perra, Teresa; Liakakos, Theodore; Daskalakis, Theodoros; Liakakos, Theodoros; Barnes, Thomas; Koëter, Tijmen; Zalla, Tiku; E González, Tomás; Elosua, Tomás; Campagnaro, Tommaso; Brown, Tommy; Luoto, Topi; Alpha Oumar, Touré; Giustizieri, Ugo; Grossi, Ugo; Bracale, Umberto; Rivas, Uriel; Sosa, Valentina; Testa, Valentina; Andriola, Valeria; Tonini, Valeria; Balassone, Valerio; Celentano, Valerio; Progno, Valerio; Raju, Varun; Carroni, Vanessa; Cavallaro, Venera; Rao Katta, Venkateswara; De Simone, Veronica; Primo Romaguera, Vicent; Hugo García Orozco, Victor; Luraschi, Victor; Rachkov, Victor; Turrado-L, Victor; Visag-Castillo, Victor; Dowling, Victoria; Graham, Victoria; Papagni, Vincenzo; Vigorita, Vincenzo; Cordeiro Fonseca, Vinicius; Jimenez Carneros, Virginia; Bellato, Vittoria; Gonçalves, Walyson; F Powers, William; Grigg, William; O Bechstein, Wolf; Bing Lim, Yu; Altinel, Yuksel; Golubović, Zoran; Balciscueta, Zutoia. - In: BRITISH JOURNAL OF SURGERY. - ISSN 0007-1323. - 108:6(2021), pp. 717-726. [10.1002/bjs.11999]

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE appy study

Francesco Pata;Gaetano Gallo;Angelo Iossa;Maria Irene Bellini;
2021

Abstract

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19∙8 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6∙6 and 2∙4 per cent respectively before, but 23∙7 and 5∙3 per cent, during the pandemic (both P < 0∙001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2.
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