Pediatria Clínica: Acesso Aberto
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Long Duration and Increase in Pediatric Complicated Appendicitis during the Period of Lockdown in April 2022 in Shanghai

Hui Li, Weijue Xv, Xiong Huang, Qingxing Li, Yibo Wu

Objective: The Corona Virus Disease 2019 (COVID-19) has tremendously transformed medical care worldwide, and elective surgery has been affected. The aim of the current study was to determine whether complicated appendicitis rates in children were influenced by the lockdown in April 2022 in Puxi region of Shanghai due to COVID-19.

Background: The progression of acute appendicitis from simple to complicated is affected by the presentation timeliness. In the context of city-mandated control, the influences of lockdown in Puxi April on children suffering from acute appendicitis will be investigated in this study.

Methods: The medical records of all children presenting in 2 hospitals with acute appendicitis between April 1 and April 30, 2022 (The first lockdown month in Puxi region) were reviewed and analyzed as the lockdown group. Moreover, the medical records of the latest 2 years of acute appendicitis in the same period were reviewed and analyzed as the control group. In addition, the clinical and laboratory parameters, treatment ways, intraoperative and pathological findings, and postoperative outcomes were analyzed.

Results: A total of 22 children were diagnosed with acute appendicitis in the first month of the lockdown period in 2 hospitals. Compared with a 2-year control cohort of acute appendicitis, we observed a longer mean duration of symptoms (67.2 ± 77.6 vs. 31.9 ±3 4.7 h, P=0.01) and higher rate (72.73% vs. 43.75%, P=0.038) in children with complicated appendicitis and a long operation time (92.5 ± 35.46 vs. 71.25 ± 34.44 min, P=0.03), as well as a higher CRP (61.82 ± 49.75 vs. 23.43 ± 28.19 mg/dL, P<0.001) and serum bilirubin (19.07 ± 11.07 vs. 10.74 ± 4.37 umol/L, P<0.0001). The mean length of stay was longer in the lockdown group than that in the control group (10.77 ± 5.37 vs.7.70 ± 3.74 d, P=0.0072). The admission WBC and neutrophil percentage had no significant differences, the mean number of hospital or clinic visits had no differences, and the interval between diagnosis and operation has no statistical differences (5.28 ± 2.94 vs. 3.73 ± 3.11 h, P=0.076). However, the overall conservative treatment cases, postoperative morbidity and mortality did not change.

Conclusion: The lockdown affected the symptoms’ duration time of pediatric acute appendicitis. The children in the lockdown period demonstrated higher complicated appendicitis compared with the historical controls, as well as longer mean length of hospital stay.