AB133. SOH26AB_0405. Impact of the COVID-19 pandemic on management and outcomes of acute appendicitis: a systematic review of conservative and operative approaches

Background: The coronavirus disease 2019 (COVID-19) pandemic prompted substantial shifts in acute appendicitis management. Non-operative management (NOM) was increasingly adopted to reduce operative risk and conserve healthcare resources, while computed tomography (CT) imaging became pivotal in distinguishing uncomplicated from complicated disease. This systematic review evaluates pandemic-induced changes in management and outcomes, with implications for future practice.

Methods: MEDLINE, PubMed, and Embase were systematically searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing pre-pandemic and pandemic appendicitis cohorts, reporting operative and non-operative strategies, were included. Outcomes included rates of conservative management, use of radiological imaging, complications, negative appendicectomy rates, recurrence, readmission, and operative outcomes. Risk of bias was assessed with ROBINS-I; meta-analysis was performed where appropriate.

Results: Fourteen cohort studies (13,053 patients) were included. NOM increased markedly [relative risk (RR) =3.28; 95% confidence interval (CI): 1.95–5.51], paralleled by a substantial rise in CT utilization, which coincided with a significant reduction in negative appendectomy rates (RR =0.47; 95% CI: 0.28–0.78). Delayed presentation was associated with higher rates of complicated appendicitis and postoperative complications (RR =2.04; 95% CI: 1.59–2.64). Readmissions trended upward but were not statistically significant (RR =1.52; 95% CI: 0.86–2.71). This data indicates a clear pivot toward NOM during pandemic peaks, with a gradual return to operative management as healthcare capacity stabilized.

Conclusions: COVID-19 induced a paradigm shift in appendicitis management, characterized by increased adoption of NOM and CT-guided diagnostic strategies. While enhanced imaging effectively reduced negative appendectomy rates, delayed presentations contributed to elevated complication rates. Routine integration of diagnostic imaging may confer enduring clinical benefit; prospective studies are warranted to assess long-term outcomes and sustainability of pandemic-driven practice modifications.

Keywords: Acute appendicitis; computed tomography (CT); coronavirus disease 2019 (COVID-19); negative appendicectomy; non-operative management (NOM)