Clinical Scorecard: Management Strategies for Adult Appendicitis Amidst the COVID-19 Pandemic: A Preliminary Analysis of a UK Cohort

At a Glance

Key Highlights

• Operative intervention within 48 hours is standard UK practice for AA; laparoscopic appendicectomy preferred due to better outcomes.
• COVID-19 pandemic led to recommendations favoring conservative management with antibiotics and use of open surgery over laparoscopy to reduce aerosol generation.
• Early UK data during COVID-19 lockdown assessed safety and outcomes of conservative versus operative management including imaging and PPE usage.

Guideline-Based Recommendations

Diagnosis

• Use of CT scan recommended to diagnose AA and exclude perforation or alternative pathology during COVID-19 pandemic.

Management

• Operative treatment remains first-line for most AA cases in the UK, ideally laparoscopic appendicectomy within 48 hours.
• Conservative management with antibiotics recommended during COVID-19 for uncomplicated AA to reduce aerosol-generating procedures.
• Open surgery preferred over laparoscopic surgery when operative intervention is necessary during the pandemic.

Monitoring & Follow-up

• 30-day follow-up to assess complications, mortality, and length of hospital stay.
• Monitor for failure of conservative management defined as need for surgery ≥2 days after initial assessment.

Risks

• Delay in presentation increases risk of appendix rupture and mortality.
• Surgery in COVID-19 positive patients associated with high mortality.
• Aerosol generation during laparoscopic surgery poses infection risk to healthcare workers.

Patient & Prescribing Data

Adults diagnosed with acute appendicitis presenting during the UK COVID-19 lockdown.

Conservative management with antibiotics and/or interventional radiology drainage was used more frequently during the pandemic; operative management included open and laparoscopic approaches with PPE precautions.

Clinical Best Practices

• Perform early operative intervention within 48 hours for uncomplicated AA when feasible.
• Utilize CT imaging to confirm diagnosis and exclude complications, especially during pandemic conditions.
• Adopt conservative antibiotic management for uncomplicated AA during high-risk periods such as COVID-19 to reduce aerosol exposure.
• Prefer open surgery over laparoscopic approach when surgery is necessary in COVID-19 positive or suspected patients.
• Ensure appropriate PPE use for all surgical staff during procedures to minimize infection risk.
• Monitor patients closely for failure of conservative management and be prepared to convert to surgery if needed.

References

• Association of Surgeons of Great Britain and Ireland COVID-19 Research Group
• REDCap - Research Electronic Data Capture