Appendicitis during the COVID-19 lockdown: results of a multicenter analysis in Germany

Abstract

Purpose The COVID-19 pandemic has transformed medical care worldwide. General surgery has been affected in elective procedures, yet the implications for emergency surgery are unclear. The current study analyzes the effect of the COVID-19 lockdown in spring 2020 on appendicitis treatment in Germany. Methods Hospitals that provided emergency surgical care during the COVID-19 lockdown were invited to participate. All patients diagnosed with appendicitis during the lockdown period (10 weeks) and, as a comparison group, patients from the same period in 2019 were analyzed. Clinical and laboratory parameters, intraoperative and pathological findings, and postoperative outcomes were analyzed. Results A total of 1915 appendectomies from 41 surgical departments in Germany were included. Compared to 2019 the number of appendectomies decreased by 13.5% (1.027 to 888, p= 0.003) during the first 2020 COVID-19 lockdown. The delay between the onset of symptoms and medical consultation was substantially longer in the COVID-19 risk group and for the elderly. The rate of complicated appendicitis increased (58.2 to 64.4%), while the absolute number of complicated appendicitis decreased from 597 to 569, ( p= 0.012). The rate of negative appendectomies decreased significantly (6.7 to 4.6%; p= 0.012). Overall postoperative morbidity and mortality, however, did not change. Conclusion The COVID-19 lockdown had significant effects on abdominal emergency surgery in Germany. These seem to result from a stricter selection and a longer waiting time between the onset of symptoms and medical consultation for risk patients. However, the standard of emergency surgical care in Germany was maintained. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02090-3.

The impact of COVID-19 pandemic lockdown on the incidence and outcome of complicated appendicitis

“…Patient attendance at emergency departments around the world during the first wave of the COVID-19 pandemic declined dramatically [15][16][17][18]. This decline may be attributed to patient's trepidation of contracting the COVID-19 virus and disease at hospitals and trying to whether their illnesses by themselves at home.…”

Trends in Pediatric Appendicitis and Imaging Strategies During Covid-19 in the United States

“…A recent multi-institutional study conducted in Germany by Willms et al analyzed appendicitis in both adults and children during the pandemic compared to pre-COVID-19 (18). The study included 1915 appendectomies in adults from 41 sites across Germany and analyzed complicated appendicitis cases in 2019 compared to 2020 (18).…”

“…A recent multi-institutional study conducted in Germany by Willms et al analyzed appendicitis in both adults and children during the pandemic compared to pre-COVID-19 (18). The study included 1915 appendectomies in adults from 41 sites across Germany and analyzed complicated appendicitis cases in 2019 compared to 2020 (18). In keeping with Willms et al paper, our data demonstrate the proportion of complicated appendicitis increased, however in our study, the count of complicated appendicitis remained steady from the previous years, while Willms et al demonstrated a slight decrease in the count of complicated appendicitis cases (18).…”

“…The study included 1915 appendectomies in adults from 41 sites across Germany and analyzed complicated appendicitis cases in 2019 compared to 2020 (18). In keeping with Willms et al paper, our data demonstrate the proportion of complicated appendicitis increased, however in our study, the count of complicated appendicitis remained steady from the previous years, while Willms et al demonstrated a slight decrease in the count of complicated appendicitis cases (18). The Willms et al study also concluded that the frequency and count of uncomplicated acute appendicitis cases decreased during COVID-19, which they attribute to a decrease in negative appendectomies and incidental appendectomies (18).…”

Auswirkung von COVID-19 auf die elektive und notfallmäßige Kolorektalchirurgie

“…Wenn ärztliche Hilfe in Anspruch genommen wurde, war die Zeit bis zur Vorstellung in einer Notaufnahme leicht verlängert im Vergleich zu Präpandemiezeiten [ 32 ]. Hieraus lässt sich schließen, dass Patienten mit persistierenden Beschwerden weiterhin ärztliche Hilfe gesucht haben, wohingegen man mutmaßen kann, dass Patienten mit milden Beschwerden in Zeiten einer globalen Pandemie zunächst abgewartet haben, worunter bei einigen die Beschwerden bereits regredient waren, sodass insgesamt keine ärztliche Behandlung mehr notwendig war.…”