Emergency Appendectomy Practices in Italy During COVID-19: CRAC Study Findings

Overview

The CRAC study revealed a 31% reduction in emergent appendectomies in Italy during the COVID-19 pandemic (March–April 2020) compared to the same period in 2019. Patients operated on in 2020 presented with more severe appendicitis, and surgical practices adapted accordingly.

Background

The COVID-19 pandemic drastically impacted global healthcare systems, leading to a significant reduction in elective surgeries worldwide. Emergency surgeries, including appendectomies, could not be postponed, but concerns about operator safety and patient outcomes influenced surgical decision-making. Early pandemic guidelines recommended non-operative management and cautioned against laparoscopy. The CRAC study aimed to evaluate changes in emergent appendectomy practices in Italy during the pandemic compared to the previous year.

Data Highlights

Key Findings

• There was a 31% decrease in emergent appendectomies during March–April 2020 compared to the same period in 2019.
• Patients operated on in 2020 had significantly higher severity of appendicitis as measured by the Appendicitis Inflammatory Response (AIR) score (p=0.036).
• The median age of patients did not differ significantly between the two periods (p=0.526).
• Surgical techniques and timing, as well as complication rates and mortality, were analyzed to assess pandemic impact on outcomes.
• Machine learning models were employed to predict surgical complications using clinical and procedural variables.

Clinical Implications

Clinicians should be aware that during pandemic conditions, delays or changes in healthcare access may lead to patients presenting with more severe appendicitis. Surgical teams must balance infection control measures with timely operative management to optimize outcomes. The increased severity underscores the importance of maintaining emergency surgical capacity even during healthcare crises.

Conclusion

The COVID-19 pandemic led to a significant reduction in emergent appendectomies in Italy, with operated patients exhibiting more severe disease. These findings highlight the need for adaptive surgical strategies and vigilance in managing acute appendicitis during public health emergencies.

References

1. CRAC Study, Italian Society of Endoscopic Surgery and New Technologies, 2021 -- Emergency Appendectomy Practices in Italy Amidst the COVID-19 Pandemic