Non-Operative Treatment for Simple Acute Appendicitis (NOTA) in Children during COVID -19 Era: New Lessons from the Pandemic

Abstract Background: Coronavirus (COVID-19) is the newest pandemic disease. The surgical management of acute appendicitis was the gold standard, but new studies suggest the safety of antibiotics treatment alone. NOTA avoid surgery, risks of general anesthesia; long hospital stay and risk of corona virus exposure. We aim to study the safety, cost effectiveness and outcome of NOTA during Covid-19 pandemic and compare it to Single incision pediatric endo-surgery appendectomy (SIPESA) Methods A prospective cohort study for NOTA of patients from 6–12 years old in Covid-19 pandemic period from 1st April 2020 to 30th April 2021. Patients divided in 2 groups: Group S managed by SIPESA; group N managed by NOTA. Family education and assurance with detailed explanation was done for early detection of any complication and we continue monitoring of the patients until complete recovery. Results sixty patients were managed. Group S had 24 cases (40%), mean age 9.3 years. Group N had 36 cases (60%), mean age 9.1 years. six cases (17%) in group N were converted to surgical management in first 6 month of study. Mean length of hospital stay dropped from 72 hours to 18 hours. The mean cost dropped from 2736$/day to 400$/day. Mean psychological stress for the children improved from 4.4 in April to 2 in September. Mean follow up was 3.5 months. Conclusions NOTA is safe and cost-effective. we recommend it especially during the COVID-19 pandemic. Level of evidence: Cost Effectiveness Study: Level II