Diagnostic outcomes in suspected appendicitis before and during the COVID-19 pandemic

ABSTRACT

Introduction: Routine operative treatment of appendicitis was temporarily interrupted during the COVID-19 pandemic. Non-operative management in suspected appendicitis makes a definitive diagnosis difficult. This study investigated diagnostic outcomes of suspected appendicitis patients before and during COVID-19. Method: A retrospective review of patients aged 16-45 undergoing treatment for suspected appendicitis pre-COVID-19 (1st January 2019- 1st January 2020) and during the COVID-19 pandemic (1st March 2020 to 31st June 2020) was performed. Patients were followed up for one year (31st June 2021) to explore diagnostic outcomes. Results: At one year follow up, 206 patients were identified in the pre-COVID-19 cohort with 100% (n=206) undergoing an appendicectomy. On histopathological examination 77.2% (n=159) had appendicitis;10.7% (n=22) another pathology;2.9% (n=6) neuroendocrine tumour. There were 62 patients in the COVID-19 cohort in which 79% (n=49) underwent appendicectomy (56% (n=35) immediate appendicectomy;23% (n=13) interval appendicectomy). On histopathological examination 61% (n=38) had appendicitis;13% (n=8) another pathology;5% (n=3) neuroendocrine tumour. Of the remaining 13/62 patients, one had undergone a CT scan and colonoscopy for gastrointestinal symptoms demonstrating signs of chronic caecal inflammation treated conservatively. One underwent a CT scan alone for gastrointestinal symptoms finding no pathology. The remaining 11/62 patients had no further reported symptoms or diagnostics. Conclusions: This study demonstrates that the risk of appendiceal malignancy and chronic inflammation is important in non-operative management of suspected appendicitis and establishing consistent follow up pathways is essential.