Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations
on the management of acute appendicitis have been based on expert opinion, but very little evidence is
available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis.
Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current
attitude of surgeons globally regarding the management of patients with acute appendicitis during
the pandemic. Questions were divided into baseline information, hospital organization and screening,
personal protective equipment, management and surgical approach, and patient presentation before
versus during the pandemic.
Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most
hospitals were treating both patients with and those without COVID. There was variation in screening
indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest
(19⋅8 per cent). Conservative management of complicated and uncomplicated appendicitis was used
by 6⋅6 and 2⋅4 per cent respectively before, but 23⋅7 and 5⋅3 per cent, during the pandemic (both
P < 0⋅001). One-third changed their approach from laparoscopic to open surgery owing to the popular
(but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement
on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction
in the number of patients admitted with appendicitis and one-third felt that patients who did present had
more severe appendicitis than they usually observe.
Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The
fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated
in the early phase of SARS-CoV-2.