The Severity of Appendicitis During the COVID-19 Pandemic: A Single Institution Experience

Abstract

Introduction

The COVID-19 pandemic led to nationwide stay at home orders, leading to delays in medical care. We sought to identify if the severity of appendicitis changed during the pandemic due to these delays and if there were differences in appendicitis severity in patients with simultaneous COVID-19 infection. We hypothesized that pandemic-related restrictions led to more severe cases of appendicitis.

Methods

We performed a retrospective study (4/2018-4/2022) of all patients ≥ 5y with appendicitis. Patients with a malignant appendiceal specimen were excluded. Clinical outcomes and characteristics were compared in those with appendicitis prior to the COVID-19 (PC) era to those in the COVID-19 (C) era, as well as between COVID-19 positive (C+) and negative (C-) individuals. Univariate analyses were conducted. A P-value <0.05 was considered to be statistically significant.

Results

A total of 1665 patients met inclusion criteria, 806 (48.4%) in PC era, and 859 (51.6%) in C era. Age and gender did not differ from PC era to C era, nor did they differ from the C- group to the C+ group. The C era had significantly higher 30-day readmissions than the PC era (C 6.29% (n = 54) v. PC 2.73% (n = 22), P = 0.001). The C era also had more greater than 30-day readmissions than the PC era (C 3.26% (n = 28) v. PC 1.74% (n = 14), P = 0.048). There was no significant difference in the reason for 30-day or greater than 30-day readmissions for the PC vs C eras. Of the C era, 833 (97.0%) were C- and 26 (3.0%) were C+. Rates of nonoperative management at index admission were not different between groups. The white blood cell (WBC) count was significantly lower in C+, 11.9 (8.55-13.35 IQR), vs C- group, 12.85 (9.9-15.3 IQR), P = 0.0336. There was no significant difference in the severity of appendicitis nor readmission status in C+ vs C- groups during the C era.

Conclusion

Our data indicates that the PC era had more severe cases of appendicitis as shown by higher rates of perforated and gangrenous appendicitis on pathology reports compared to the C era. Interestingly, readmissions were more prevalent in the C era as opposed to the PC era, which coincided with an increase in complications requiring readmission following laparoscopic appendectomies. In evaluating appendicitis patients according to COVID-19 status, we saw no significant differences in the severity of appendicitis in C- and C+ individuals.