Clinical Scorecard: Emergency Appendectomy Practices in Italy Amidst the COVID-19 Pandemic: Findings from a Multicenter Ambispective Cohort Study by the Italian Society of Endoscopic Surgery and New Technologies (CRAC Study)

At a Glance

Key Highlights

• 31% reduction in emergent appendectomies during March–April 2020 compared to the same period in 2019.
• Increased severity of appendicitis cases during the pandemic as measured by AIR and AAST scores.
• Shift in surgical practice with initial recommendations favoring non-operative management and caution with laparoscopy.

Guideline-Based Recommendations

Diagnosis

• Use Appendicitis Inflammatory Response (AIR) score and American Association for the Surgery of Trauma (AAST) score to assess severity.

Management

• Consider non-operative management for uncomplicated appendicitis during pandemic conditions.
• Laparoscopy remains the standard surgical approach despite initial pandemic recommendations against its use.
• Delay surgery beyond 24 hours after diagnosis should be monitored carefully.

Monitoring & Follow-up

• Monitor post-operative complications using the Dindo–Clavien grading system.
• Track 30-day mortality and need for radiological or surgical re-intervention.

Risks

• Increased risk of complications associated with delayed surgery and higher severity scores.
• Potential worsening of COVID-19 pneumonia post general anesthesia.

Patient & Prescribing Data

Adults undergoing emergent appendectomy during the COVID-19 pandemic in Italy

Significant reduction in surgical volume with higher severity cases treated surgically; non-operative management increased initially; laparoscopy still preferred when surgery performed.

Clinical Best Practices

• Use validated scoring systems (AIR, AAST) to stratify appendicitis severity and guide management.
• Prioritize timely surgery for complex appendicitis cases to reduce complications.
• Employ laparoscopy as the standard surgical technique when feasible, with precautions for COVID-19 safety.
• Monitor patients closely post-operatively for complications and intervene promptly if needed.
• Balance risks of COVID-19 exposure and surgical delay in decision-making.

References

• Global COVID-19 impact on surgery
• Non-operative management of appendicitis
• AAST appendicitis grading
• Dindo–Clavien classification
• Appendicitis Inflammatory Response (AIR) score