Impact of COVID-19 on presentation,management,and outcomes of acute care surgery for gallbladder disease and acute appendicitis  

作　　者：Orly Nadell Farber Giselle I Gomez Ashley L Titan Andrea T Fisher Christopher J Puntasecca Veronica Toro Arana Arielle Kempinsky Clare E Wise Kovi E Bessoff Mary T Hawn James R Korndorffer Jr Joseph D Forrester Micaela M Esquivel 

机构地区：[1]Department of Surgery,Stanford University School of Medicine,Palo Alto,CA 94305,United States

出　　处：《World Journal of Gastrointestinal Surgery》2021年第8期859-870,共12页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND The ongoing coronavirus disease 2019(COVID-19)pandemic has significantly disrupted both elective and acute medical care.Data from the early months suggest that acute care patient populations deferred presenting to the emergency department(ED),portending more severe disease at the time of presentation.Additionally,care for this patient population trended towards initial non-operative management.AIM To examine the presentation,management,and outcomes of patients who developed gallbladder disease or appendicitis during the pandemic.METHODS A retrospective chart review of patients diagnosed with acute cholecystitis,symptomatic cholelithiasis,or appendicitis in two EDs affiliated with a single tertiary academic medical center in Northern California between March and June,2020 and in the same months of 2019.Patients were selected through a research repository using international classification of diseases(ICD)-9 and ICD-10 codes.Across both years,313 patients were identified with either type of gallbladder disease,while 361 patients were identified with acute appendicitis.The primary outcome was overall incidence of disease.Secondary outcomes included presentation,management,complications,and 30-d re-presentation rates.Relationships between different variables were explored using Pearson’s r correlation coefficient.Variables were compared using the Welch’s t-Test,Chi-squared tests,and Fisher’s exact test as appropriate.RESULTS Patients with gallbladder disease and appendicitis both had more severe presentations in 2020.With respect to gallbladder disease,more patients in the COVID-19 cohort presented with acute cholecystitis compared to the control cohort[50%(80)vs 35%(53);P=0.01].Patients also presented with more severe cholecystitis in 2020 as indicated by higher mean Tokyo Criteria Scores[mean(SD)1.39(0.56)vs 1.16(0.44);P=0.02].With respect to appendicitis,more patients were diagnosed with a perforated appendix at presentation in 2020[20%(36)vs 16%(29);P=0.02]and a greater percentage were classified

关 键 词：COVID-19 CHOLECYSTITIS Biliary colic APPENDICITIS Acute care surgery 

分 类 号：R473.6[医药卫生—护理学]