The impact of Victorian COVID‐19 lockdowns on the presentation and management of acute appendicitis

Abstract

Backgrounds The COVID‐19 pandemic presents ongoing challenges for healthcare. Stay at Home orders (‘lockdowns’) and community fears have been suggested to create reluctance to seek healthcare. We aimed to determine whether the rates of perforated appendicitis and negative appendicectomy have been affected by the pandemic, and to analyse the effect of lockdowns on the management of acute appendicitis in Victoria. Methods We conducted a retrospective audit of emergency appendicectomies performed under adult General Surgery units at Monash Health in Victoria from January 2019 to September 2021, including 242 days of lockdown. Results 2459 patients were included. Fewer patients had perforated appendicitis during the second lockdown (6.3% versus 10.7% baseline; p = 0.027). The rate of negative appendicectomy was reduced during the first lockdown (4.1% versus 14.9% baseline; p = 0.002) and during intervals between lockdown in 2021 (9.8%; p = 0.010). There was no difference in the rate of perforated appendicitis or negative appendicectomy at other times. Time to surgery and number of appendicectomies performed were also not significantly different. Fewer appendicectomies were performed after hours during lockdowns and in 2021 more generally compared to baseline (p < 0.05). Conclusion The lower negative appendicectomy rate during the first lockdown may reflect increased pre‐operative imaging or clinical observation for undifferentiated presentations. There was a reduction in perforated appendicitis during the second lockdown, and no significant difference at other times. Contrary to other studies, lockdowns associated with the COVID‐19 pandemic may not create a reluctance to seek healthcare in all regions.

Management of acute appendicitis during the COVID-19 pandemic: a retrospective cohort study

“…In our cohort, the negative appendicectomy rate nearly halved during the pandemic to 5.7%, whilst the rate of CT prior to operation increased by approximately 10%. Studies during the pandemic also noted the same significant reduction in negative appendicectomy, and have reported a rate as low as 0% [ 23 , 25 , 26 , 29 ]. Their studies also identified higher rates of CT use.…”

The Implementation Experience of COVID-19 Rapid Antigen Testing in a Large-Scale Construction Project in Victoria, Australia

“…Large-scale lockdowns were used to prevent extensive community transmission of COVID-19 in Australia. In the state of Victoria, there were six lockdowns totaling 242 days between 2020 and 21 (Rajagopalan et al, 2022 ). Except for a 2-week period during the 6th lockdown, construction industries were permitted to work with restrictions on workforce size (Victorian Building Authority, 2021 ).…”