Royal College of Surgeons in Ireland
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Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective

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journal contribution
posted on 2023-02-21, 07:49 authored by Maximilian Peter Forssten, Lewis J. Kaplan, Matti Tolonen, Isidro Martinez‑Casas, Yang Cao, Thomas N. Walsh, Gary Alan Bass, Shahin Mohseni, ESTES SnapAppy Group

Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy.

Methods: Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15 years who underwent appendectomy for appendicitis (November 2020-May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model.

Results: Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications.

Conclusion: During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.


Open access funding provided by Örebro University



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Published Citation

Forssten MP, et al. Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective. Eur J Trauma Emerg Surg. 2023;49(1):57-67.

Publication Date

19 January 2023

PubMed ID



  • RCSI Bahrain


Springer Nature


  • Published Version (Version of Record)