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Where have all the appendicectomies gone?

N G Mowbray1, L Hurt2, A Powell-Chandler3

  • 1University Hospital of Wales, Cardiff, UK.

Annals of the Royal College of Surgeons of England
|March 8, 2021
PubMed
Summary
This summary is machine-generated.

The COVID-19 lockdown led to fewer acute appendicitis cases and altered treatments. Increased CT scans identified simple appendicitis, enabling conservative management and reducing negative appendectomy rates.

Keywords:
Antibacterial agentsAppendicectomyAppendicitisCOVID-19

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Area of Science:

  • General Surgery
  • Infectious Disease Epidemiology
  • Public Health Policy

Background:

  • The COVID-19 pandemic prompted a national lockdown in the UK, advising against hospital visits and aerosol-generating procedures.
  • This led to a hypothesis that acute appendicitis presentations and treatment choices would change.

Purpose of the Study:

  • To investigate the impact of the COVID-19 lockdown on acute appendicitis incidence and management.
  • To compare patient presentation, diagnostic methods, and treatment strategies before and during the lockdown.

Main Methods:

  • A multicentered, prospective observational study was conducted in April 2020.
  • Adult patients treated for acute appendicitis were identified.
  • Data were compared with records from April 2018 and April 2019.

Main Results:

  • A significant decrease in acute appendicitis cases was observed during lockdown (64 patients) compared to pre-lockdown (190 patients).
  • Patients during lockdown had higher ASA scores and delayed presentation.
  • Computed tomography (CT) use increased (36.3% to 85.9%), antibiotic-only treatment rose (6.2% to 40.6%), and laparoscopic appendicectomy decreased (85.3% to 17.2%).
  • The negative appendicectomy rate fell from 21.7% to 7.1%.

Conclusions:

  • The COVID-19 lockdown was associated with reduced acute appendicitis incidence and a shift in management.
  • Increased CT utilization facilitated conservative treatment for simple appendicitis.
  • This approach led to a lower negative appendicectomy rate.