Surgical Versus Conservative Management of Acute Appendicitis During the Covid-19 Pandemic

Abstract

Background: We aim to analyse the management of patients presenting with AA to our institution during the first wave of the pandemic, comparing surgically and conservatively managed patients
 Method: Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcomes were length of hospital stay and Alvarado score.
 Results: Higher complication rates were observed amongst the conservatively managed group, although not found to be statistically significant (16.67% vs 34.78%; p=>0.05). There was no significant difference in length of hospital stay observed between the two groups (surgical: 2.31±1.02 days vs conservative: 2.62±1.12 days).
 Conclusions: COVID-19 has led to a significant cohort of conservatively managed AA patients. We propose a stratification pathway based on clinical severity, Alvarado score and imaging to facilitate safe selection for conservative management of AA, in order to reduce failure of treatment rates in this patient group.
 Keywords: Appendicectomy, Appendicitis, Conservative, Coronavirus