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Increased Incidence of Perforated Appendicitis in Children During COVID-19 Pandemic in a Bavarian Multi-Center Study

Frank-Mattias Schäfer1, Johannes Meyer1, Stephan Kellnar2

  • 1Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nuremberg, Germany.

Frontiers in Pediatrics
|May 24, 2021
PubMed

Insights

The COVID-19 pandemic lockdown in Bavaria led to a significant increase in perforated appendicitis rates in children, particularly in younger boys. This suggests delayed healthcare-seeking behavior during the pandemic may have serious consequences.

Area of Science:

  • Pediatric Surgery
  • Public Health
  • Epidemiology

Background:

  • The COVID-19 pandemic caused significant disruptions to healthcare, including reduced access to primary care and cancellation of elective surgeries.
  • These changes may have negatively impacted pediatric acute care, potentially leading to adverse outcomes.
  • The spring 2020 lockdown in Bavaria prompted a review of its effects on pediatric surgical emergencies.

Purpose of the Study:

  • To investigate the rate of perforated appendicitis in children during the spring 2020 lockdown in Bavaria.
  • To compare these rates with pre-pandemic periods (2018-2019) to identify any significant changes.
  • To analyze potential demographic or age-related differences in perforation rates during the lockdown.

Main Methods:

  • A state-wide, multi-center retrospective study was conducted in Bavaria.
  • Data from children operated on for appendicitis during the spring 2020 lockdown were analyzed.
  • A control group of children operated on during the corresponding periods in 2018 and 2019 was used for comparison.

Main Results:

  • A total of 514 patients were included; 176 in 2020 and 338 in 2018-2019.
  • The perforation rate in 2020 was 27.8%, significantly higher than the 20.7% rate in 2018-2019 (p=0.0359).
  • Subgroup analysis revealed significantly higher perforation rates in younger children (≤11.2 years) and in boys during the 2020 lockdown compared to the control period.

Conclusions:

  • The rate of perforated appendicitis in childhood significantly increased in Bavaria during the COVID-19 curfew regulations.
  • This increase was particularly pronounced in younger children and boys, suggesting delayed presentation to pediatric surgical care.
  • The findings highlight the need to consider potential collateral damage from public health measures during pandemics to ensure adequate patient care.

Keywords:
COVID-19appendicitispandemicperforated appendicitisperforation

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