EP.WE.613A multi-centre review of the management of acute appendicitis during the COVID-19 pandemic

Abstract

AimAcute appendicitis is a common surgical presentation and is historically a clinical diagnosis; gold-standard treatment is appendicectomy. Due to anticipated increased demand on in-patient beds during the COVID-19 pandemic there was increased emphasis on conservative management of acute appendicitis. Our aim is to review these changes and determine the representation rate following conservative management.MethodsPatients with acute appendicitis were identified from daily referral lists across two trusts. Data was collected using electronic care records. A control group (106 patients) was identified from 3 months preceding the pandemic.ResultsIn the pandemic group, 213 patients had acute appendicitis; 47% were managed conservatively, compared to 8% of the control group. Overall, during the pandemic 44% of patients had a CT-confirmed diagnosis (compared to 48% of control group); the two trusts’ results varied showing 75% and 30% (compared to 46% and 51% respectively in the control group). Of those treated conservatively only 3% represented to hospital and required admission.ConclusionSignificantly more patients were treated conservatively during the COVID-19 pandemic. The larger number of patients managed as acute appendicitis in the pandemic group may represent over-diagnosis due to the decision to conservatively manage these patients and account for diagnostic uncertainty. Increased access to early diagnostic CT scans facilitated early decisions regarding definitive management. Variation in access to radiology both during and before the pandemic may account for the difference in use of CT scans. Low rates of readmission to hospital following conservative management of acute appendicitis have been observed to date.