Management of Acute Appendicitis during the COVID-19 Pandemic: A Single Tertiary Center Experience

Background: The coronavirus disease-2019 (COVID-19) outbreak had an effect on healthcare. Objectives: To evaluate the presentation and management of patients with acute appendicitis. Methods: A retrospective study was conducted of all patients presenting with acute appendicitis to the emergency department of a large tertiary center during March and April 2020. Clinical features, diagnostic workup, and management were compared. Results: Seventy-four patients presented with acute appendicitis during the pandemic compared to 60 patients during the same time the year before. There were no significant differences in patient demographics: age (P = 0.65), gender (P = 0.73), smoking status (P = 0.48). During COVID-19 patients were more likely to complain of right tower quadrant pain (100% vs. 78.3%, P < 0.01). Rates of surgical treatment was similar (83.8% vs. 81.7%, P = 1); mean operative time was longer during COVID-19 (63 +/- 23 vs. 52 +/- 26 minutes, P= 0.03). There were no significant differences in intra-operative findings including the presence of appendiceal perforation (16.3% vs. 14.5%, P = 0.8), abscess (6.1% vs. 9.7%, P = 0.73), or involvement of cecum or terminal ileum (14.28% vs. 19.63%, P = 1). Postoperative treatment with antibiotics was more prevalent during COVID-19 (37.1% vs. 18%, P= 0.04). Length of stay (1.82 2.04 +/- vs. 2.74 4.68 +/-, P = 0.2) and readmission rates (6% vs. 11.3%, P =0.51) were similar. Conclusion: The COVID-19 pandemic did not significantly affect the presentation, clinical course, management, and outcomes of patients presenting with acute appendicitis.