University of Edinburgh

Dr Regina Prigge

DL_2023_028

The aim of this project is to establish the impact of the recent COVID-19 pandemic on the management approach to emergency surgical conditions. As a model condition, we will use one of the most common emergency surgical conditions; acute appendicitis. Appendicitis can be managed definitively with surgical operation, or conservatively with antibiotic administration alone. The latter poses the risk of recurrent appendicitis and is often elected by patients as an alternative to admission and operative management. We aim to compare recurrence rates of acute appendicitis in patients managed without surgery before and during the COVID-19 pandemic. Any occurring significant differences will provide evidence that the pandemic has had an impact on physicians’ treatment approach, and patient views regarding the fear of hospitalization. Part of the project is to identify individual risk factors for the election of surgical versus non-operative management of appendicitis during the pandemic.

Acute appendicitis is one of the most common emergency surgical conditions encountered in all grades of medical practice, with reports mentioning an incidence rate of 1.1 cases per 100.000 people, per year. The severity of acute appendicitis is largely determined by the presence of complications such as purulent peritonitis. In turn, complicated appendicitis, when present, dictates surgical treatment as the preferred one. The most prominent issue regarding the comparison of the two approaches is the recurrence of acute appendicitis, shortly after successful conservative management. The recent COVID-19 pandemic has had great effects on patient healthcare access, which was translated into more hesitation towards hospitalization and surgical interventions. Current literature suggests that the incidence of complicated acute appendicitis has risen during the COVID-19 pandemic. Proportions of surgically managed patients were found to be lower compared to the pre-pandemic period (81% vs 94%) with higher rates of reported perforations (31% vs 16%). Conservative management of acute appendicitis was also reported to be higher than pre-pandemic standards. Recurrence rates however were significantly higher in the nonoperative treatment group during the pandemic period, with a reported incidence of 18%. Therefore, the question remains to be answered: Has the COVID-19 pandemic, inclusive of the strain on healthcare systems and avoidance of the public towards hospitalization, attenuated the non-operative management election of acute appendicitis? As of now, there is a lack of studies examining the relationship between the COVID-19 pandemic, the increased nonoperative management rates of acute appendicitis, and the recurrence rates during the pandemic. This study will provide important public health evidence that could be utilised by the NHS in future pandemics to help inform patients of the dangers of non-operative management of appendicitis, which could also potentially reduce the overall burden of appendicitis-related consultations on the NHS.

Public Health Research

13/12/2023

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