The impact of Victorian COVID-19 lockdowns on the presentation and management of acute appendicitis

Area of Science:

• General Surgery
• Epidemiology
• Public Health

Background:

• The COVID-19 pandemic and associated Stay at Home orders (lockdowns) may impact healthcare-seeking behavior.
• Concerns exist regarding potential reluctance to seek medical care due to community fears during the pandemic.
• Understanding the effects of these measures on acute surgical conditions like appendicitis is crucial.

Purpose of the Study:

• To determine if the rates of perforated appendicitis and negative appendicectomy were affected by the COVID-19 pandemic.
• To analyze the specific impact of lockdowns on the management of acute appendicitis in Victoria.

Main Methods:

• Retrospective audit of emergency appendicectomies performed at Monash Health, Victoria.
• Data collected from January 2019 to September 2021, encompassing 242 days of lockdown.
• Analysis included 2459 patient cases.

Main Results:

• A significant reduction in perforated appendicitis was observed during the second lockdown (6.3% vs. 10.7% baseline, p=0.027).
• The rate of negative appendicectomy decreased during the first lockdown (4.1% vs. 14.9% baseline, p=0.002) and during 2021 intervals (9.8%, p=0.010).
• No significant differences in time to surgery or overall appendicectomy numbers were noted; however, fewer procedures occurred after hours during lockdowns.

Conclusions:

• The findings suggest that lockdowns may not universally lead to increased reluctance to seek healthcare for appendicitis.
• Reduced negative appendicectomy rates could indicate enhanced diagnostic strategies or clinical observation during lockdowns.
• The observed decrease in perforated appendicitis during the second lockdown warrants further investigation into pandemic-related healthcare utilization patterns.