COVID-19-specific risk factor for early post-appendectomy complications (EPAC) in older patients: a retrospective study - Report - MDSpire

COVID-19-specific risk factor for early post-appendectomy complications (EPAC) in older patients: a retrospective study

  • By

  • Tamer A. A. M. Habeeb

  • A. Hussain

  • Jose Bueno-Lledó

  • M. E. Giménez

  • A. Aiolfi

  • M. Chiaretti

  • I. A. Kryvoruchko

  • M. N. Manangi

  • Abd Al-Kareem Elias

  • Abdelmonem A.M Adam

  • Mohamed A. Gadallah

  • Saad Mohamed Ali Ahmed

  • Ahmed Khyrallh

  • Mohammed H. Alsayed

  • Esmail Tharwat Kamel Awad

  • Emad A. Ibrahim

  • Mohammed Hassan Elshafey

  • Mohamed fathy Labib

  • Mahmoud Hassib Morsi Badawy

  • Sobhy rezk ahmed Teama

  • Abdelhafez Seleem

  • Mohamed Ibrahim Abo Alsaad

  • Abouelatta KH Ali

  • Hamdi Elbelkasi

  • Mahmoud Ali abou zaid

  • Basma Ahmed Mohamed

  • Alaa Alwadees

  • Ahmed k. El-Taher

  • Mohamed Ibrahim Mansour

  • Mahmoud Abdou Yassin

  • Ahmed Salah Arafa

  • Mohamed Lotfy

  • Baher Atef

  • Mohamed Elnemr

  • Mostafa M Khairy

  • Abdelfatah H. Abdelwanis

  • ahmed mesbah Abdelaziz

  • Abdelshafy Mostafa

  • AbdElwahab M. Hamed

  • Tamer Wasefy

  • Ibrahim A. Heggy

  • Abdelrahman Mohamed Hasanin Nawar

  • November 5, 2025

  • 0 min

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COVID-19-related Risk Factors for Early Post-Appendectomy Complications in Elderly Patients

Overview

This retrospective multicenter study analyzed elderly patients undergoing appendectomy during the COVID-19 pandemic to identify risk factors for early post-appendectomy complications (EPAC). Active COVID-19 infection during hospital admission was evaluated as a potential risk factor alongside clinical and demographic variables.

Background

Acute appendicitis (AA) is the most common emergency abdominal surgery worldwide, with increasing incidence in older adults due to demographic shifts. Older patients often present atypically, leading to delayed diagnosis and higher rates of complications such as perforation and abscess formation. The COVID-19 pandemic altered surgical care pathways, including preferences for open versus laparoscopic appendectomy, potentially impacting postoperative outcomes. Understanding COVID-19-related risk factors for EPAC in elderly patients is critical for optimizing management during and after the pandemic.

Data Highlights

The study included elderly patients (≥60 years) from four tertiary centers in Egypt between April 2020 and December 2024. Variables collected included age, sex, ASA score, smoking status, WBC count, coronary heart disease, diabetes, hypertension, clinical frailty scale, Charlson Comorbidity Index, previous abdominal surgeries, history of appendicitis, and COVID-19 infection status (active or past). The primary outcome was the incidence of early post-appendectomy complications within 30 days, including surgical site infections, intra-abdominal abscesses, and ileus.

Key Findings

  • Older patients with active COVID-19 infection during hospital admission had a higher risk of early post-appendectomy complications.
  • Delayed diagnosis in elderly patients contributed to increased rates of complicated appendicitis and postoperative morbidity.
  • Higher ASA scores, increased clinical frailty, and elevated Charlson Comorbidity Index scores were associated with greater risk of EPAC.
  • Open appendectomy was more commonly performed during the pandemic due to concerns about viral aerosolization, potentially influencing complication rates.
  • Common early complications included surgical site infections, intra-abdominal abscesses, and ileus.

Clinical Implications

Clinicians should carefully assess elderly patients with acute appendicitis for active COVID-19 infection, as it may increase postoperative complication risks. Preoperative evaluation of frailty and comorbidity burden can guide surgical decision-making and perioperative management. Adjustments in surgical approach during the pandemic should balance infection control with optimal patient outcomes.

Conclusion

Active COVID-19 infection and patient frailty are significant risk factors for early complications following appendectomy in elderly patients. Tailored perioperative strategies are essential to improve outcomes in this vulnerable population during and beyond the COVID-19 pandemic.

References

  1. Zagazig University Ethics Review Committee 2020 -- Study Approval and Protocol
  2. WHO 2020 -- Ageing and Health Fact Sheet

Original Source(s)

COVID-19-specific risk factor for early post-appendectomy complications (EPAC) in older patients: a retrospective study

  • by Tamer A. A. M. Habeeb, A. Hussain, Jose Bueno-Lledó, M. E. Giménez, A. Aiolfi, M. Chiaretti, I. A. Kryvoruchko, M. N. Manangi, Abd Al-Kareem Elias, Abdelmonem A.M Adam, Mohamed A. Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H. Alsayed, Esmail Tharwat Kamel Awad, Emad A. Ibrahim, Mohammed Hassan Elshafey, Mohamed fathy Labib, Mahmoud Hassib Morsi Badawy, Sobhy rezk ahmed Teama, Abdelhafez Seleem, Mohamed Ibrahim Abo Alsaad, Abouelatta KH Ali, Hamdi Elbelkasi, Mahmoud Ali abou zaid, Basma Ahmed Mohamed, Alaa Alwadees, Ahmed k. El-Taher, Mohamed Ibrahim Mansour, Mahmoud Abdou Yassin, Ahmed Salah Arafa, Mohamed Lotfy, Baher Atef, Mohamed Elnemr, Mostafa M Khairy, Abdelfatah H. Abdelwanis, ahmed mesbah Abdelaziz, Abdelshafy Mostafa, AbdElwahab M. Hamed, Tamer Wasefy, Ibrahim A. Heggy, Abdelrahman Mohamed Hasanin Nawar

  • November 5, 2025

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