The impact of COVID-19 pandemic lockdown on the incidence and outcome of complicated appendicitis

Yaron Rudnicki, Hagai Soback, Ori Mekiten, Guy Lifshiz, Shmuel Avital, Yaron Rudnicki, Hagai Soback, Ori Mekiten, Guy Lifshiz, Shmuel Avital

Abstract

Background: Patient attendance at emergency departments (EDs) during the COVID-19 pandemic outbreak has decreased dramatically under the "stay at home" and "lockdown" restrictions. By contrast, a notable rise in severity of various surgical conditions was observed, suggesting that the restrictions coupled with fear from medical facilities might negatively impact non-COVID-19 diseases. This study aims to assess the incidence and outcome of complicated appendicitis (CA) cases during that period.

Methods: A retrospective study comparing the rate and severity of acute appendicitis (AA) cases during the COVID-19 initial outbreak in Israel during March and April of 2020 (P20) to the corresponding period in 2019 (P19) was conducted. Patient data included demographics, pre-ED status, surgical data, and postoperative outcomes.

Results: Overall, 123 patients were diagnosed with acute appendicitis, 60 patients during P20 were compared to 63 patients in P19. The rate of complicated appendicitis cases was significantly higher during the COVID-19 Lockdown with 43.3% (26 patients) vs. 20.6% (13 patients), respectively (p < 0.01). The average delay in ED presentation between P20 and P19 was 3.4 vs. 2 days (p = 0.03). The length of stay was 2.6 days in P20 vs. 2.3 days in P19 (p = 0.4), and the readmission rate was 12% (7 patients) vs. 4.8% (3 patients), p = 0.17, respectively. Logistic regression demonstrated that a delay in ED presentation was a significant risk factor for complicated appendicitis (OR 1.139, CI 1.011-1.284).

Conclusion: The effect of the COVID-19 initial outbreak and Lockdown coupled with hesitation to come to medical facilities appears to have discouraged patients with acute appendicitis from presenting to the ED as complaints began, causing a delay in diagnosis and treatment, which might have led to a higher rate of complicated appendicitis cases and a heavier burden on health care systems.

Trial registration: ClinicalTrials.gov NCT04786041.

Keywords: Acute appendicitis; COVID-19 pandemic; Complicated appendicitis; Lockdown; Stay at home.

Conflict of interest statement

Dr. Yaron Rudnicki, Dr. Hagai Soback, Mr. Ori Mekiten, Dr. Guy Lifshiz, and Dr. Shmuel Avital declare no conflict of interest.

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Figures

Fig. 1
Fig. 1
A A comparison of the mean duration of pre-emergency department (ED) symptoms in days between the P19 and P20 groups. B A comparison of the percentage of cases with peri-appendicular findings on imaging (CT and US) between P19 and P20 groups. C A comparison of the percentage of cases with complicated appendicitis found in surgery between P19 and P20 groups

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