47 - Management Practices of Pediatric Acute Appendicitis Before and During the Covid-19 Pandemic

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 47
Publication Number: 47.112

Shivani S. Shah, Newark Beth Israel Medical Center, Iselin, NJ, United States; PAYAL SHAH, Newark Beth Israel, Hoboken, NJ, United States; Vaishali Shah, Rutgers New Jersey Medical School, Edison, NJ, United States

Presenting Author(s)

Shivani S. Shah, DO (she/her/hers)

Fellow Physician
Newark Beth Israel Medical Center
Iselin, New Jersey, United States

Background: Acute appendicitis is a common surgical emergency in children requiring prompt treatment to prevent rupture. Current management guidelines involve antibiotics and performing an urgent appendectomy. There has been a growing debate that was further ignited during the pandemic about the utility of nonoperative treatment in some cases of pediatric appendicitis, as this carries a lower risk of general anesthesia and post-surgical complications. The COVID-19 pandemic may have also resulted in a hesitancy among patients to seek medical care as well as delays in surgery, increasing the risk of complications.

Objective:
We aim to see if during the COVID-19 pandemic patients with appendicitis presented with longer duration of symptoms, an increased incidence of complicated appendicitis, and a shift towards medical management.

Design/Methods:
A retrospective comparative analysis was done of patients presenting to an urban teaching pediatric emergency department with acute appendicitis between March 2018 to February 2022 to investigate any differences in the presentations, management practices and outcomes two years prior to and during the Covid 19 pandemic. We queried our electronic medical record for patients given Zosyn or Ceftriaxone as this is the antibiotic of choice for appendicitis in our institution. We included patients with diagnostic imaging or ICD-10 confirmed appendicitis and excluded those who were transferred from an outside institution or were immunocompromised.

Results: We identified 118 cases and 149 cases of appendicitis prior to and during the pandemic, respectively. The patients’ presentation between the two time periods significantly differed in race, migration of pain and the presence of anorexia (Table 1). There was a significant difference with a greater proportion of patients managed only medically or medically with an interval appendectomy during the pandemic regardless of complicated or uncomplicated appendicitis (Table 2). Complications after being treated medically with interval appendectomy were significantly higher compared to those treated with standard surgical management.

Conclusion(s): During the COVID-19 pandemic, patients with appendicitis had no increased odds of complicated appendicitis despite longer duration of symptoms. There were increased odds of late complications with non-surgical management compared to surgical management. These findings may help elucidate the best candidates for non-operative treatment when medical surge volumes impact surgical decision making.