• Jochem C G Scheijmans, Alexander B J Borgstein, PuylaertCarl A JCAJDepartment of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Wouter J Bom, Said Bachiri, Eduard A van Bodegraven, Amarins T A Brandsma, Floor M Ter Brugge, de CastroSteve M MSMMDepartment of Surgery, OLVG, Amsterdam, the Netherlands., Roy Couvreur, Lotte C Franken, Marcia P Gaspersz, Michelle R de Graaff, Hannah Groenen, Suzanne C Kleipool, Toon J L Kuypers, Milou H Martens, David M Mens, Ricardo G Orsini, Nando J M M Reneerkens, Thomas Schok, Wouter J A Sedee, Shahzad Tavakoli Rad, José H Volders, Pepijn D Weeder, Jan M Prins, Hester A Gietema, Jaap Stoker, Suzanne S Gisbertz, BesselinkMarc G HMGHDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Marja A Boermeester, and SCOUT Collaboarative Study group.
• Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
• BMC Emerg Med. 2021 May 12; 21 (1): 61.

BackgroundDuring 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.MethodsWe 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.ResultsThe 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).ConclusionsAlthough 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.

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