Introduction: The COVID-19 pandemic introduced novel challenges for healthcare systems. This study compares the incidence of simple versus complicated appendicitis, hospital length of stay (LOS), and non-operative management (NOM) during the initial five-month COVID-19 lockdown of 2020 against various pre- and post-reference periods. Methods: We conducted a retrospective analysis of all patients diagnosed with appendicitis between March 31, 2017, and August 31, 2022. Data from the reference period (March 31-August 31, 2020) were compared with shorter identical-calendar-period comparators from 2017 to 2022, as well as with longer comparator time periods consisting of consecutive 36 months preceding and 24 months succeeding the reference period. Results: A total of 1094 patients were included in the analysis, of which 87 were in the reference period. The shorter comparator periods included 63, 74, 92, 106, and 109 patients in 2017, 2018, 2019, 2021, and 2022, respectively. The longer comparator periods comprised 540 patients in the 36 months preceding the reference period and 467 patients in the 24 months succeeding it. Mean age and gender distribution were similar across all comparator periods, except in post-reference periods, where mean heart rates decreased and CT scan use increased. There were no significant differences in the rates of complicated appendicitis between the reference period (26.5%) and shorter comparator periods (34.9% in 2017, 17.6% in 2018, 19.6% in 2019, 33.0% in 2021, and 23.9% in 2022; p = 0.07). Similarly, complicated appendicitis rates were unchanged when compared to the longer comparator periods (24.1% preceding vs. 25.9% succeeding; p = 0.76). LOS adjusted for clinical and demographic features was significantly longer in 2018 (p = 0.03), 2019 (p = 0.01), and 2022 (p = 0.01) when compared to the reference period and to 2021. NOM did not differ significantly across the shorter comparator periods (p = 0.51) but was higher in the 24 months succeeding (17.3%) than the 36 months preceding (9.1%; p < 0.001). Conclusions: During the initial COVID-19 lockdown reference period, the proportion of simple versus complicated appendicitis remained unchanged. Hospital LOS was shorter during the reference period and in 2021 compared to other periods. Although unchanged during the reference period, NOM rates increased over the succeeding years.
Trotter et al. (Wed,) studied this question.