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Comparative Study
. 2021 May 12;21(1):61.
doi: 10.1186/s12873-021-00454-y.

Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis: a comparison between 2019 and 2020

Jochem C G Scheijmans #  1 , Alexander B J Borgstein #  2 , Carl A J Puylaert  3 , Wouter J Bom  1 , Said Bachiri  4 , Eduard A van Bodegraven  5 , Amarins T A Brandsma  6 , Floor M Ter Brugge  7 , Steve M M de Castro  8 , Roy Couvreur  9 , Lotte C Franken  10 , Marcia P Gaspersz  11 , Michelle R de Graaff  12 , Hannah Groenen  13 , Suzanne C Kleipool  8 , Toon J L Kuypers  14 , Milou H Martens  15 , David M Mens  16 , Ricardo G Orsini  17 , Nando J M M Reneerkens  18 , Thomas Schok  19 , Wouter J A Sedee  20 , Shahzad Tavakoli Rad  21 , José H Volders  22 , Pepijn D Weeder  23 , Jan M Prins #  24 , Hester A Gietema #  25 , Jaap Stoker #  3 , Suzanne S Gisbertz #  2 , Marc G H Besselink #  2 , Marja A Boermeester #  26 ; SCOUT Collaboarative Study group
Collaborators, Affiliations
Comparative Study

Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis: a comparison between 2019 and 2020

Jochem C G Scheijmans et al. BMC Emerg Med. .

Abstract

Background: During the COVID-19 pandemic, a decrease in the number of patients presenting with acute appendicitis was observed. It is unclear whether this caused a shift towards more complicated cases of acute appendicitis. We compared a cohort of patients diagnosed with acute appendicitis during the 2020 COVID-19 pandemic with a 2019 control cohort.

Methods: We retrospectively included consecutive adult patients in 21 hospitals presenting with acute appendicitis in a COVID-19 pandemic cohort (March 15 - April 30, 2020) and a control cohort (March 15 - April 30, 2019). Primary outcome was the proportion of complicated appendicitis. Secondary outcomes included prehospital delay, appendicitis severity, and postoperative complication rates.

Results: The COVID-19 pandemic cohort comprised 607 patients vs. 642 patients in the control cohort. During the COVID-19 pandemic, a higher proportion of complicated appendicitis was seen (46.9% vs. 38.5%; p = 0.003). More patients had symptoms exceeding 24 h (61.1% vs. 56.2%, respectively, p = 0.048). After correction for prehospital delay, presentation during the first wave of the COVID-19 pandemic was still associated with a higher rate of complicated appendicitis. Patients presenting > 24 h after onset of symptoms during the COVID-19 pandemic were older (median 45 vs. 37 years; p = 0.001) and had more postoperative complications (15.3% vs. 6.7%; p = 0.002).

Conclusions: Although the incidence of acute appendicitis was slightly lower during the first wave of the 2020 COVID-19 pandemic, more patients presented with a delay and with complicated appendicitis than in a corresponding period in 2019. Spontaneous resolution of mild appendicitis may have contributed to the increased proportion of patients with complicated appendicitis. Late presenting patients were older and experienced more postoperative complications compared to the control cohort.

Keywords: Acute appendicitis; COVID-19 pandemic; Complicated appendicitis.

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Conflict of interest statement

The authors declare that they have no competing interests. Professor Boermeester reported receiving institutional grants from J&J/Ethicon, KCI/3 M, Bard and New Compliance; and being an advisory board member and/or speaker and/or instructor for KCI/3 M, J&J/Ethicon, Allergan, Bard, Gore, Smith & Nephew. No funding was received for current study.

Figures

Fig. 1
Fig. 1
Flowchart: inclusions SCOUT-4 study cohort versus 2020
Fig. 2
Fig. 2
Daily presentations of patients with acute appendicitis
Fig. 3
Fig. 3
Total number of patients, stratified by type of acute appendicitis: 2019 control cohort vs. 2020 COVID cohort
See this image and copyright information in PMC

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