Impact of COVID-19 pandemic on outcome of acute appendicitis: a retrospective analysis

Linganagouda S. Patil, Reena Jagadeesha


Background: Acute appendicitis is the most common abdominal surgical emergency. Lockdown and stay-at-home orders are strategies that were implemented globally during the acute pandemic period of COVID-19 to prevent disease dissemination, health system overload and mortality. However, there are concerns that patients did not seek necessary health care because of these rules.

Methods: Retrospective observational study was conducted on patients who presented with acute appendicitis from January 2020 to May 2020. They were classified according to the time of presentation that is before declaration of the state of alarm (pre-COVID-19), and after its declaration (post-COVID-19) in India (24 March 2020). An evaluation was made of demographic variables, complications and duration of hospital stay in both the groups.

Results: 45 patients were included, 20 in pre-COVID-19 group and 25 in post-COVID-19 group. In post-COVID-19 group, the interval from onset of symptoms to admission was 65.0 hour, which is significantly longer than the 17.3 hour interval noted in pre-COVID-19 group (p<0.001). The prevalence of complicated appendicitis after the epidemic outbreak was significantly higher than before the outbreak (52% versus 20%, p<0.001).The mean hospital stay was longer in post-COVID-19 group (5.6±5.9 versus 3.2±4.3 days; p=0.041).

Conclusions: COVID-19 pandemic influenced the time of diagnosis of appendicitis, as well as its course, and mean hospital stay. Complicated appendicitis was more common in patients with acute appendicitis after the outbreak of COVID-19 pandemic.


Acute appendicitis, COVID-19, Complicated appendicitis, Pandemic

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Sartelli M, Baiocchi GL, Di Saverio S. Prospective Observational Study on acute Appendicitis Worldwide (POSAW). World J Emerg Surg. 2018;13:19.

Andrews MA, Areekal B, Rajesh KR, Krishnan J, Suryakala R, Krishnan B, et al. First confirmed case of COVID-19 infection in India: A case report. Indian J Med Res. 2020;151(5):490-2.

Clinical Issues and Guidance. The American College of Surgeons. Available at: https://www.facs. org/covid-19/clinical-guidance. Accessed on 24 August 2021.

Wong LE, Hawkins JE, Langness S, Murrell KL, Iris P, Sammann A. Where are all the patients? Addressing covid-19 fear to encourage sick patients to seek emergency care. NEJM catalyst innovations in care delivery. 2020. Available at: Accessed on 24 August 2021.

Bernstein L, Stead Sellers F. Patients with heart attacks, strokes and even appendicitis vanish from hospitals. The Washington Post. 2020. Available at: Accessed on 24 August 2021.

Tankel J, Keinan A, Blich O. The Decreasing Incidence of Acute Appendicitis During COVID-19: A Retrospective Multi-centre Study. World J Surg. 2020;44(8):2458-63.

Romero J, Valencia S, Guerrero A. Acute Appendicitis During Coronavirus Disease 2019 (COVID-19):Changes in Clinical Presentation and CT Findings. J Am Coll Radiol. 2020;1546-440(20)30641-4.

Solis E, Hameed A, Brown K, Pleass H, Johnston E. Delayed emergency surgical presentation: impact of corona virus disease (COVID-19) on non-COVID patients. ANZ J Surg. 2020;10.

Di Saverio S, Podda M, De Simone B. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27.

Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: study period 1993-2008. J Surg Res. 2012;175(2):185-90.