Acute appendicitis during the COVID-19 pandemic versus before pandemic period in Republic of North Macedonia

Abstract

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has impacted the outcomes of acute appendicitis. Aim: The aim of the study was to compare the characteristics of acute appendicitis (AA) in children before and during the COVID-19 pandemic. Methods: A cross sectional study was conducted at the University Clinic for pediatric surgery in Skopje, Republic of North Macedonia, between January 2019 and September 2020. We elaborated children aged ≤14 years diagnosed with AA and treated at our clinic before / during COVID-19 period. The time from the first symptoms to hospitalization, incidence of complications, type of intervention, duration of hospital stay, and postoperative use of antibiotics were compared between the two groups. Results: A total of 328 children with appendectomies were included in the study – 197 (60,1%) before (Group 1) and 131 (39,9%) during COVID 19 pandemic (Group 2). No significant differences was found between the groups related to gender (p=0,341) and age (p=0,475). The time from the first symptoms to hospitalization (p=0,031), complications (p=0,044) and use of antibiotic treatment (p=0,028) were significantly associated with Group 2. No association between the groups and AA type of intervention was found (p=0,191). Conclusion: Even with lower incidence, appendectomies in children during Covid 19 pandemic had increased rate of complications, prolonged hospitalization, and higher antibiotic use. Reason for these findings is important to be investigating, as pandemic conditions should be taken into account in children health interventions.