Higher Rates of Complicated Appendicitis During the COVID-19 Pandemic: A Year-to-Year Analysis

Amram Kupietzky; Miriam Finkin; Roi Dover; Nachum Emil Eliezer Lourie; Tzlil Mordechai-Heyn; Eyal Yonathan Juster; Haggi Mazeh; Ido Mizrahi

doi:10.1016/j.jss.2023.05.007

Higher Rates of Complicated Appendicitis During the COVID-19 Pandemic: A Year-to-Year Analysis

J Surg Res. 2023 Oct:290:304-309. doi: 10.1016/j.jss.2023.05.007. Epub 2023 May 24.

Authors

Amram Kupietzky¹, Miriam Finkin², Roi Dover³, Nachum Emil Eliezer Lourie³, Tzlil Mordechai-Heyn³, Eyal Yonathan Juster³, Haggi Mazeh³, Ido Mizrahi³

Affiliations

¹ Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel. Electronic address: amram@hadassah.org.il.
² Faculty of Medicine, Department of Military Medicine and "Tzameret", Hebrew University of Jerusalem and Medical Corps, Israel Defense Forces, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
³ Faculty of Medicine, Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.

Abstract

Introduction: The COVID-19 pandemic impacted presentation, management strategies, and patient outcomes of numerous medical conditions. The aim of this study is to perform a year-to-year comparison of clinical outcomes of patients with acute appendicitis (AA) before and during the pandemic.

Methods: Patients treated for AA during the initial 12-mo period of the pandemic at our institute were compared to those treated for AA during the 12-mo period before. Clinical and laboratory parameters, treatment strategies, intraoperative findings, pathology reports, and postoperative outcomes were compared.

Results: During the study period, 541 patients presented with AA. The median (interquartile range) age was 28 (21-40) y and 292 (54%) were males. 262 (48%) patients presented during the pre-COVID-19 period, while 279 patients (52%) presented during the COVID 19 pandemic. The groups were comparable for baseline clinical data and imaging results upon index admission. There was no significant difference in rate of nonoperative treatment between the Pre-COVID-19 and During-COVID-19 eras (51% versus 53%, P = 0.6) as well as the success rate of such treatment (95.4% versus 96.4%, P = 0.3). Significantly more patients presented with a periappendicular abscess during COVID-19 (4.6% versus 1.1%, P = 0.01) and median (interquartile range) operative time was significantly longer (78 (61-90) versus 32.5 (27-45) min, P < 0.001). Pathology reports revealed a higher rate of perforated appendicitis during COVID-19 (27.4% versus 10.2%, P < 0.001).

Conclusions: Patients with AA present with higher rates of perforated and complicated appendicitis during the COVID-19 pandemic. The success rates of nonoperative management in selected patients with noncomplicated AA did not change during the pandemic and is a safe, feasible, option.

Keywords: Acute appendectomy; Acute appendicitis; COVID-19; Conservative treatment; Coronavirus SARS-CoV-2; Nonoperative management.

MeSH terms

Abscess
Appendectomy / methods
Appendicitis* / complications
Appendicitis* / epidemiology
Appendicitis* / surgery
COVID-19* / complications
COVID-19* / epidemiology
Female
Humans
Male
Pandemics
Retrospective Studies