Acute Appendicitis During Coronavirus Disease 2019 in Turkey: Changes in Clinical Approach, Treatment, and Diagnosis Modalities, A Retrospective Cohort Study

The novel coronavirus disease 2019 (COVID-19) has resulted in major changes in health-care systems and emer-gency surgical interventions. Here, we examined patients with acute appendicitis who presented to emergency departments and com-pared diagnosis, treatment, and post-treatment processes before and during the pandemic period and investigated how the pandemic affected management of acute appendicitis.A national, multicenter, and cohort study model was designed that included patients older than 18 years of age diag-nosed with acute appendicitis clinically and/or radiologically, with patients compared before (pre-pandemic period: January 1-April 30, 2019) and after (pandemic period: January 1-April 30, 2020) the pandemic. Our investigation included comparisons of pre-operative imaging methods, presence of plastron appendicitis/abscess, conservative/surgical approach, type of anesthesia given, laparoscopic/open surgical approach, bowel resection rates, drain insertion rates, and presence of post-operative complications RESULTS: For the two study groups, 8972 patients from 69 centers were examined, with 4582 patients operated in the pre-pan-demic period and 4234 patients operated in the pandemic period. During the pandemic period, 63.6% of patients underwent open surgery, whereas 34.4% had laparoscopic surgery. Although 60 patients (1.3%) requested non-operative follow-up in the pre-pandemic period, 94 patients (2.2%) requested this in the pandemic period. When conditions of patients were evaluated regardless of their own wishes, 114 patients (2.4%) before and 163 patients (3.8%) during the pandemic received non-operative follow-up.Our study did not show the direct correlation between the application of COVID-19-related restrictions and the severity of acute appendicitis. Although non-operative management rates have been increased during the COVID-19 period, the incidences of both complicated and the uncomplicated appendicitis were similar during the COVID-19 crisis period. Given this infor-mation non-operative management can be employed for patients diagnosed with appendicitis.