Massachusetts Chapter of the American College of Surgeons

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The effect of COVID-19 on the severity of acute appendicitis: an academic center's experience
Elizabeth Santone1, Francesca Izzo1, Karina Lo1, Aixa Perez-Caraballo2, Georgios Orthopoulos1
1Department of Surgery, Baystate Medical Center, Springfield, MA; 2Baystate Medical Center, Springfield, MA

Background:
An increase in severity of acute appendicitis cases was observed following the implementation of statewide restrictions due to COVID-19 in March, 2020. We investigated if a similar change occurred during a second wave in November, 2020.

Methods:
In a retrospective cohort study of acute appendicitis patients at Baystate Medical Center, cases during wave 1 were grouped into 8 weeks before (Group A) and after (Group B) stay-at-home restrictions were initiated in Massachusetts on March 15, 2020. Cases in wave 2 were defined as 8 weeks before (Group C) and after (Group D) November 6, 2020. The groups were also compared to patients during equivalent time frames in 2018 and 2019. Incidence of acute uncomplicated appendicitis versus complicated disease was measured as the primary outcome.

Results:
Group A vs B revealed 42.6% decrease (CI: -59.4, -25.7) in uncomplicated appendicitis, 21.1% increase (CI: 4.8, 37.3) in perforated appendicitis and 23.8% increase (CI: 9.0, 38.7) in gangrenous appendicitis. A similar pattern was noted comparing Group C vs D, but without statistical significance. The change in acute appendicitis cases seen in wave 1 was significantly different than that seen in 2018/2019. This trend continued in wave 2, but with less statistical significance.

Conclusion:
Similar to wave 1, acute appendicitis cases increased in severity during wave 2 of COVID-19 infections. Comparison to previous years showed a similar trend toward increased severity in wave 2, but with less statistical significance. This potentially indicates more timely access to surgical care.


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