Massachusetts Chapter of the American College of Surgeons

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Impact of SARS-CoV-2 Pandemic on Acute Appendicitis Admissions and Severity of Illness
Miriam Y Neufeld, Sabrina E Sanchez, Frederick Thurston Drake
Boston University School of Medicine/Boston Medical Center, Boston, MA

Background: Following the declaration of the SARS CoV-2 pandemic, hospitals ceased elective procedures and, additionally, have had decreased admissions for acute illnesses. There is concern for delayed presentation and complicated disease. The objective was to determine if the declaration (March 11, 2020) decreased acute appendicitis admissions compared to a historic control and to determine if patients admitted post-declaration presented with more severe disease.
Methods: Retrospective multi-institutional cohort study examining adult patients with acute appendicitis from Dec 2019-May 2020 compared to a historic control (N=956). Primary outcome was a comparison of biweekly counts of appendicitis admissions (as well as uncomplicated and complicated appendicitis) pre- and post-declaration, assessed with Difference in Differences (DID). Secondary outcome was likelihood of presenting with complicated disease following the declaration assessed with clustered multivariable logistic regression.
Results: There was a significant decrease in acute appendicitis admissions post-declaration [DID= ? -0.43 (95% CI -0.70,-0.16), p = 0.0025]. When stratified, the decrease was significant among uncomplicated appendicitis cases alone [DID= ? -0.51 (95% CI -0.84,-0.19), p = 0.0026]. There was no increased likelihood of presenting with complicated disease following the declaration [aOR 1.36 (95% CI 0.83,2.25), p=0.2252].
Conclusion: The pandemic changed healthcare-seeking behavior with fewer uncomplicated appendicitis admissions but did not increase the likelihood of complicated appendicitis admissions. Some uncomplicated appendicitis cases likely resolve on their own and do not progress to complicated disease.


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