Increased Frequency of Perforated Appendicitis During COVID-19 First Wave
Overview
A retrospective single-center study identified a significant rise in perforated appendicitis cases during the first COVID-19 wave in 2020 compared to 2018 and 2019. This increase is likely related to delayed medical contact rather than a direct association with SARS-CoV-2 infection.
Background
Acute appendicitis is the most common emergency surgical condition with a lifetime risk of 6.7 to 8.6%. Perforated appendicitis carries a mortality rate up to 5%. During the COVID-19 pandemic, elective surgeries were postponed in Germany to allocate resources for SARS-CoV-2 patients, potentially affecting timely treatment of appendicitis. This study aimed to assess whether the frequency of perforated appendicitis increased during the pandemic due to delayed presentation or patient shifts.
Data Highlights
Year
Total Appendicitis Cases
Perforated Appendicitis Cases
Perforation Rate (%)
2018
54
12
22.22
2019
43
13
30.23
2020 (COVID-19 first wave)
46
21
44.68
Key Findings
143 patients underwent surgery for acute appendicitis over three 10-week periods in 2018, 2019, and 2020.
Perforation rates increased significantly in 2020 to 44.68% compared to 22.22% in 2018 and 30.23% in 2019 (p = 0.039).
The rise in perforated cases coincided with the first COVID-19 wave and postponement of elective surgeries in Germany.
No direct association between SARS-CoV-2 infection and appendicitis was identified.
Delayed initial medical contact due to fear of COVID-19 is a likely contributor to increased perforation rates.
Clinical Implications
Surgeons and healthcare institutions should anticipate more advanced intraoperative findings and complications in acute appendicitis cases during ongoing or future COVID-19 waves. This necessitates preparedness for intensive monitoring and potentially longer hospital stays. Prompt medical evaluation of abdominal pain should be encouraged despite pandemic-related concerns to reduce perforation risk.
Conclusion
The COVID-19 pandemic has indirectly led to a significant increase in perforated appendicitis cases, likely due to delayed presentation. Awareness and proactive management strategies are essential to mitigate complications in subsequent pandemic waves.
References
Study Authors/2020 -- Frequency of Perforated Appendicitis Cases During the COVID-19 Crisis
