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Multicenter Study
. 2021 Mar;406(2):367-375.
doi: 10.1007/s00423-021-02090-3. Epub 2021 Feb 7.

Appendicitis during the COVID-19 lockdown: results of a multicenter analysis in Germany

Arnulf G Willms  1 , Karl J Oldhafer  2 , Sophie Conze  3 , Wolfgang E Thasler  4 , Christian von Schassen  5 , Thorsten Hauer  6 , Tobias Huber  7 , Christoph-Thomas Germer  8 , Simone Günster  9 , Dirk R Bulian  10 , Zarah Hirche  11 , Jörg Filser  12 , Gregor A Stavrou  13 , Martin Reichert  14 , Patrizia Malkomes  15 , Steffen Seyfried  16 , Tobias Ludwig  17 , Hans C Hillebrecht  18 , Dimitrios Pantelis  19 , Stefanie Brunner  20 , Wilm Rost  5 , Johan F Lock  8 ; CAMIN Study Group
Collaborators, Affiliations
Multicenter Study

Appendicitis during the COVID-19 lockdown: results of a multicenter analysis in Germany

Arnulf G Willms et al. Langenbecks Arch Surg. 2021 Mar.

Abstract

Purpose: The COVID-19 pandemic has transformed medical care worldwide. General surgery has been affected in elective procedures, yet the implications for emergency surgery are unclear. The current study analyzes the effect of the COVID-19 lockdown in spring 2020 on appendicitis treatment in Germany.

Methods: Hospitals that provided emergency surgical care during the COVID-19 lockdown were invited to participate. All patients diagnosed with appendicitis during the lockdown period (10 weeks) and, as a comparison group, patients from the same period in 2019 were analyzed. Clinical and laboratory parameters, intraoperative and pathological findings, and postoperative outcomes were analyzed.

Results: A total of 1915 appendectomies from 41 surgical departments in Germany were included. Compared to 2019 the number of appendectomies decreased by 13.5% (1.027 to 888, p=0.003) during the first 2020 COVID-19 lockdown. The delay between the onset of symptoms and medical consultation was substantially longer in the COVID-19 risk group and for the elderly. The rate of complicated appendicitis increased (58.2 to 64.4%), while the absolute number of complicated appendicitis decreased from 597 to 569, (p=0.012). The rate of negative appendectomies decreased significantly (6.7 to 4.6%; p=0.012). Overall postoperative morbidity and mortality, however, did not change.

Conclusion: The COVID-19 lockdown had significant effects on abdominal emergency surgery in Germany. These seem to result from a stricter selection and a longer waiting time between the onset of symptoms and medical consultation for risk patients. However, the standard of emergency surgical care in Germany was maintained.

Keywords: Appendicitis; COVID-19; Complicated appendicitis; Emergency surgery; Multicenter study; SARS-CoV-2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Duration of symptoms prior to medical consultation. a In COVID-19 risk group. b In elderly patients ≥ 75 years
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