Massachusetts Chapter of the American College of Surgeons

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The effect of COVID-19 pandemic on the incidence of acute appendicitis
Elizabeth Santone MD1, Francesca Izzo MD1, Aixa M. Pérez-Caraballo MS, MPH1, Michael Tirabassi MD2, Nicolas Jabbour MD1, George Orthopoulos MD, PhD1
1Baystate Medical Center-University of Massachusetts School of Medicine, Springfield, MA 2Baystate Children's Hospital-University of Massachusetts School of Medicine, Springfield, MA

Background: In Massachusetts, elective surgeries were postponed on March 15, 2020 in response to the novel coronavirus (COVID-19) pandemic. Administrative bodies similarly recommended stay-at-home restrictions for citizens. We investigated if the introduction of COVID-19 restrictions impacted the number and disease burden of acute appendicitis cases.
Methods: A retrospective review of acute appendicitis admissions at Baystate Medical Center between January 1, 2018 and April 30, 2020 was performed. Two groups were created: 6 weeks before (Group A) and after (Group B) postponement of elective surgeries. We compared Groups A and B from 2020 to similar groups from 2018/2019.
Results: We identified 180 adult and 101 pediatric patients. Comparison between Groups A and B in 2020 revealed a 45.5% decrease (CI:-64.2,-26.7) in uncomplicated appendicitis after implementation of COVID-19 restrictions. An increase of 21.1% (CI:3.9,38.3) in perforated and an increase of 29% (CI:11.5,46.5) in gangrenous appendicitis was noted. Comparison of similar groups in 2020 and 2018/2019 revealed a significant decrease (46.1%, CI:24.2,68.1) in uncomplicated appendicitis as well as significant increase in perforated (-19.7%, CI:-39.7,0.3) and gangrenous (-32.1%, CI:-50.9,-13.4) appendicitis.
Conclusion: Our study revealed a significant increase in complicated appendicitis and simultaneous significant decrease in uncomplicated appendicitis during the COVID-19 pandemic. The direct correlation between COVID-19 restrictions and severity of acute appendicitis illustrates the importance of seeking timely surgical care.


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