Clinical Report: Management of Adult Appendicitis During COVID-19 in UK Cohort

Overview

This interim analysis of 500 adult patients with acute appendicitis during the UK COVID-19 lockdown reveals a significant shift towards conservative management with antibiotics and reduced laparoscopic surgery use. Early findings suggest that non-operative treatment was safely implemented with careful patient selection, and imaging with CT scans was widely adopted to guide management.

Background

Acute appendicitis (AA) is the most common general surgical emergency worldwide, with a lifetime risk of approximately 7-9%. In the UK, laparoscopic appendicectomy is the standard treatment due to its advantages over open surgery. However, the COVID-19 pandemic raised concerns about aerosol generation during surgery, leading to recommendations favoring conservative management and open surgery when operative intervention was necessary. This study aims to evaluate the impact of these changes on AA management and 30-day outcomes during the early pandemic period.

Data Highlights

Key Findings

• Conservative management with antibiotics was increasingly used as first-line treatment during the COVID-19 lockdown.
• Laparoscopic appendicectomy rates decreased due to concerns about aerosol generation; open surgery was preferred when operative intervention was necessary.
• CT imaging was widely adopted to confirm diagnosis and exclude complicated appendicitis before deciding management strategy.
• Failure of conservative management was defined as progression to surgery after ≥2 days; outcomes were analyzed on an intention-to-treat basis.
• 30-day complication rates and mortality were monitored to assess safety of altered management pathways.
• Personal protective equipment (PPE) usage and COVID-19 status were recorded to evaluate infection control measures.

Clinical Implications

Clinicians should consider conservative antibiotic management as a safe initial approach for selected adult patients with uncomplicated acute appendicitis during pandemic conditions or resource constraints. CT imaging is valuable in guiding treatment decisions and minimizing unnecessary surgery. When surgery is indicated, open appendicectomy may reduce aerosol exposure risks, but patient outcomes and local resources should guide operative approach.

Conclusion

This preliminary UK cohort analysis demonstrates that a shift towards conservative management and modified surgical strategies for acute appendicitis during the COVID-19 pandemic is feasible and can be safely implemented with appropriate patient selection and imaging. Further follow-up will clarify long-term outcomes and inform future guidelines.

References

1. UK COVID-19 Appendicitis Study Group 2020 -- Management Strategies for Adult Appendicitis Amidst the COVID-19 Pandemic