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Appendicitis in the COVID-19 era: a modern challenge for experienced hands

C Brown1, J Waterman1, E El Hitti2

  • 1Prince Charles Hospital, UK.

Annals of the Royal College of Surgeons of England
|June 30, 2021
PubMed

Insights

Delayed presentations of appendicitis during COVID-19 led to more complex cases. Despite increased severity, postoperative complications did not rise, offering lessons for future public health crises.

Area of Science:

  • General Surgery
  • Infectious Disease Epidemiology

Background:

  • The COVID-19 pandemic caused global uncertainty and delayed patient hospital presentations.
  • Surgical pathologies, including appendicitis, saw delayed presentations during the initial COVID-19 wave.

Purpose of the Study:

  • To assess if delayed presentations of appendicitis during the first COVID-19 wave resulted in more complex appendicectomies.
  • To analyze changes in appendicitis patient presentation and surgical management during the pandemic.

Main Methods:

  • Retrospective analysis of 216 appendicitis operation notes from a single health board.
  • Comparison of appendicitis severity (using American Association for the Surgery of Trauma (AAST) grading) between a pre-COVID control period and the first COVID-19 wave.
  • Analysis of symptom duration, white cell count, preoperative imaging, and consultant presence.

Main Results:

  • Appendicitis presentations were delayed during COVID-19 (median 2 days vs 1 day, p=0.003) with higher white cell counts.
  • Preoperative CT scanning increased significantly (OR 3.013, p<0.001).
  • More complex appendicectomies (AAST grade >1) were performed (OR 2.102, p=0.015) with greater consultant presence (OR 4.740, p<0.001), but no increase in postoperative complications was observed.

Conclusions:

  • Delayed patient presentations during the COVID-19 pandemic were associated with more complex appendicitis cases.
  • Despite increased appendicitis severity, surgical outcomes did not worsen, indicating resilience in care delivery.
  • Lessons learned from pandemic-induced practice changes can inform future healthcare responses.
Abstract

Keywords:
AppendicitisEmergencyGastrointestinalGeneral surgery

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