Estudo epidemiológico sobre a influência da pandemia de COVID-19 na apendicite aguda em hospital público - Salvador, Bahia

Abstract

Introduction – During the COVID-19 pandemic, patients with acute appendicitis (AA) found the health system overloaded and, in many centers, it was difficult to care for patients with the virus and abdominal emergencies, with some difficulty in accessing a hospital bed and possible clinical consequences. Objective – To compare the frequency, severity and outcomes of acute appendicitis in a public referral hospital for emergency abdominal surgery in the city of Salvador, Bahia, in the trans-pandemic period of COVID-19 with the pre-pandemic period. Methodology – Inspired by an ecological study, using biological and patient profile variables, the retrospective study comprised two series with all patients undergoing appendectomy at the Salvador Municipal Hospital (HMS) from March 1, 2019 thru February 28, 2020 (pre-pandemic period) and from March 1, 2020 thru February 28, 2021 (first transpandemic year). Severity variables (time of symptom evolution, AA classification by severity and anesthetic risk profile), types of surgery and outcomes (hospital stay, complications and mortality) were studied for comparative analysis. Results – A total of 882 patients underwent appendectomies due to AA were studied, with 412 found in the transpandemic series (2020) and 470 appendectomies in the previous year (2019). The average time from AA symptoms to surgical intervention during the pandemic was 4.2 days (median = 3.0 days) versus 3.5 days (median = 2.0 days) in the period without the pandemic. Rates of acute perforated appendicitis reached 33.4% in 2020 (during the pandemic) against 27.3% in 2019. During the pandemic, 20 (twenty) appendectomies were included for acute appendicitis in the presence of symptoms and/or positive serology for COVID -19, which resulted in four deaths and a mortality rate of 20% in this association. During the pandemic, the mortality rate was approximately 3 times higher (1.7%), when compared to the mortality of appendectomy patients during the pandemic (0.6%). The length of hospital stay was an average of 4.4 days during the transpandemic, while it was 3.4 days pre-pandemic. Laparoscopic appendectomy was the most used technique pre-pandemic (65.3%) while during the trans-pandemic open appendectomies predominated (55.1%). Postoperative complications in the pandemic series were 29.3%, compared to 23.8% before the pandemic. Reoperations were necessary in 10.7% during the pandemic period compared to 5.5% in 2019. The rate of negative appendectomies was maintained in both periods at 4.2 and 4.4%, respectively. Conclusion – The impact of the COVID-19 pandemic produced significant changes in the time of evolution of symptoms, diagnosis and surgical treatment of AA, related to greater severity, rate of reoperations, length of hospital stays and postoperative complications.