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Global Incidence of Appendectomy: A Population-Based Study of the Organisation for Economic Co-operation and
Elizabeth M Buie1,2, Stephanie Coward1,3,4, Michael J Buie1,3
1From the Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.
Study Design:
Retrospective, observational, multi-region population-based cohort study.
Objective:
To determine temporal changes in appendectomy incidence over time and compare appendectomy rates before and during the COVID-19 pandemic.
Background:
Appendicitis is a common cause of abdominal pain presenting to emergency departments. However, temporal trends of appendicitis rates vary globally.
Methods:
We conducted a population-based observational cohort study using data from regions in the Organisation for Economic Co-operation and Development across 2000 to 2023. Poisson regression, or negative binomial if overdispersion was present, was used to calculate the average annual percentage change (AAPC) in appendectomy rates per 100,000 person-years with associated 95% confidence intervals (CI). Davies' test was used to identify inflection points. AAPCs were pooled across regions using meta-analysis. Incidence rate ratios were calculated using Poisson, or negative binomial regression, comparing rates before (2018-2019) and during (2020-2021) the pandemic and pooled across regions using meta-analysis.
Results:
The pooled AAPC was -0.75% (95% CI: -0.86 to -0.53%). Appendectomy rates were significantly decreasing in 24 regions, significantly increasing in seven, and remaining stable in nine. Inflection points were found in 30 regions, and 17 regions showed a reversal in trend direction after the inflection. The pooled incidence rate ratios estimate before and during the pandemic was 0.94 (95% CI: 0.91-0.97).
Conclusions:
Appendectomy rates across Organisation for Economic Co-operation and Development regions declined by 0.75% annually, with an additional 6% drop during the COVID-19 pandemic. Geographic variability likely reflects differences in healthcare access, diagnostic practices, and non-surgical management. Ongoing surveillance is essential to understand evolving trends and guide surgical planning and global health policy.
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