Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2022; 10(29): 10487-10500
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10487
Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis
Sami Akbulut, Adem Tuncer, Zeki Ogut, Tevfik Tolga Sahin, Cemalettin Koc, Emek Guldogan, Ertugrul Karabulut, Elif Seren Tanriverdi, Ali Ozer
Sami Akbulut, Tevfik Tolga Sahin, Cemalettin Koc, Ertugrul Karabulut, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Sami Akbulut, Emek Guldogan, Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Sami Akbulut, Ali Ozer, Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Adem Tuncer, Zeki Ogut, Department of Surgery, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Elif Seren Tanriverdi, Department of Medical Microbiology, Inonu University Medical Faculty, Malatya 44280, Turkey
Author contributions: Akbulut S, Tuncer A, Ogut Z, Tanriverdi ES, and Koc C collected data; Akbulut S and Ozer A performed statistical analysis; Akbulut S and Sahin TT wrote the manuscript; Akbulut S, Sahin TT, and Yilmaz S contributed to project development and reviewed the final version.
Institutional review board statement: This study was reviewed and approved by the Inonu University institutional review board for non-interventional studies (2021/2293).
Informed consent statement: Verbal and written consents were obtained from all patients who underwent appendectomy.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: There are no additional data available for this study.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, FACS, MD, PhD, Professor, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10 Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Received: July 25, 2022
Peer-review started: July 25, 2022
First decision: August 7, 2022
Revised: August 16, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: October 16, 2022

Acute appendicitis (AAp) is the most frequent cause of acute abdominal pain, and appendectomy is the most frequent emergency procedure that is performed worldwide. The coronavirus disease 2019 (COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.


To compare the demographic, clinical, and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.


The demographic, clinical, biochemical, and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19 (October 2018-March 2020) and COVID-19 (March 2020-July 2021) periods.


Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period. Pre-COVID-19 (n = 154) and COVID-19 (n = 223) periods were compared for various parameters, and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio (OR): 1.76; P = 0.018], presence of AAp findings on ultrasonography (OR: 15.4; P < 0.001), confirmation of AAp in the histopathologic analysis (OR: 2.6; P = 0.003), determination of perforation in the appendectomy specimen (OR: 2.2; P = 0.004), the diameter of the appendix (P < 0.001), and hospital stay (P = 0.003). There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19 (median: 24 h; interquartile range: 34) and COVID-19 (median: 36 h; interquartile range: 60) periods (P = 0.348). The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status (P < 0.001).


The present study showed that in the COVID-19 period, the ultrasonographic determination rate of AAp, perforation rate of AAp, and duration of hospital stay increased. On the other hand, negative appendectomy rate decreased. There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.

Keywords: SARS-CoV-2, COVID-19 pandemic, Acute appendicitis, Perforated appendicitis, Negative appendectomy

Core Tip: The World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic as a public health emergency of international concern. Previous studies have shown that the anxiety related with the fear of the COVID-19 pandemic has caused individuals to avoid admission to hospitals even in very urgent conditions. The present study showed that the complicated acute appendicitis rate increased, which has led to prolonged hospital stays during the COVID-19 pandemic. The present study also showed that the negative appendectomy rate decreased during the pandemic.