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. 2025 Apr 16;25(1):159.
doi: 10.1186/s12893-025-02897-7.

SARS-CoV-2 infection and complicated appendicitis in adults in Lima, Peru: a matched case-control study

Agustín Mansilla-Sandoval  1 , Diana Corrales-Delgado  1 , Zully M Puyén  1 , Percy Mansilla-Doria  1   2 , Edwin Orendo-Velásquez  2 , Luis Huicho  3 , Diego Fano-Sizgorich  4
Affiliations

SARS-CoV-2 infection and complicated appendicitis in adults in Lima, Peru: a matched case-control study

Agustín Mansilla-Sandoval et al. BMC Surg. .

Abstract

Background: Acute appendicitis may be uncomplicated or may present with life threatening complications. Since the outbreak of the COVID-19 pandemic, there has been an increase in the number of cases of complicated appendicitis, suggesting a possible association between them. Therefore, we aimed to determine the association between SARS-CoV-2 infection and complicated appendicitis in surgical patients in Lima, Peru, from March 2020 to December 2021.

Methods: A matched case-control study was conducted. Clinical records of patients ≥ 18 years old who underwent surgery for appendicitis and had at least one positive SARS-CoV-2 diagnostic test were selected. Patients undergoing surgery for complicated appendicitis were considered cases, and patients undergoing surgery for uncomplicated appendicitis were controls. A 1:1 matching by sex, age, and month of surgery was performed. Conditional logistic regression modeling was performed to calculate crude and adjusted conditional odds ratios (cOR).

Results: The positivity rate for COVID-19 tests was 73.6% for cases and 26.4% for controls. The crude cOR was 4.88 (95% IC 2.89-8.23, p < 0.001), and the adjusted cOR was 3.52 (95%IC 1.82-6.81, p = 0.001), after controlling for onset time of symptoms and awaiting time before surgery.

Conclusions: Surgery for complicated appendicitis was associated with SARS-CoV-2 infection. Patients with this infection may be at higher risk of complicated appendicitis and thus may need additional clinical monitoring.

Keywords: Acute appendicitis; COVID-19; Complicated appendicitis; Latin America; SARS-CoV-2.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study adhered to the Declaration of Helsinki and received approval by Universidad Peruana de Ciencias Aplicadas Institutional Review Board (FCS-CEI/1070-11-21), Red Almenara EsSalud IRB (Carta N°003 OlyD-GRPA-ESSALUD-2023) and Universidad Peruana Cayetano Heredia IRB (CONSTANCIA-CIEI-373-35-23). Given that no personal information was retrieved from the clinical records, the need for consent was waived by the institutional review boards. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Proposed causal pathway. The green circle with an arrow inside is the exposure variable. The blue circle with an “I” inside is the outcome variable. Blue circles are observed variables. Red circles are confounders. A direct arrow from one variable to another denotes a causal relationship. SOT: symptoms onset time. ATBS: awaiting time before surgery. SES: socio-economic status. BMI: body mass index
See this image and copyright information in PMC

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