Increased Incidence of Adult Complicated Appendicitis in One Resource-Competent Community during the Coronavirus Disease 2019 Pandemic: Time to Improve Health-Seeking Behaviors

Abstract BackgroundThe impact of the coronavirus disease 2019 (COVID-19) pandemic on medical services is overwhelming due to limited medical resources. During its initial surge in 2020, Taiwan’s government rapidly established diverse public actions, which helped maintain the medical supply without travel restrictions. However, whether the fear of being infected with COVID-19 interfered with health-seeking behavior (HSB) remains unclear. Therefore, this study aimed to elucidate whether acute complicated appendicitis (ACA) rates in adults were affected by the COVID-19 pandemic.MethodsA retrospective analysis of acute appendicitis in adults was performed between January 1 and June 30, 2020 (COVID-19 period). The control period was collected from the first two quarters for the preceding 3 years. Outcome measures were ACA and length of hospital stays.ResultsA total of 145 patients with acute appendicitis presented to our institution during the COVID-19 era. Compared to a 3-year control cohort of 320 patients, the COVID-19 pandemic was associated with a higher rate of symptom duration until their presentation to the emergency room within >48 h (17.2% vs 9.1%, P = 0.011), a higher incidence of ACA (29.7% vs 19.4%, P = 0.014), and a longer length of hospital stays (5.0 days vs 4.0 days, P = 0.043) were observed. In the adjusted regression analysis, the COVID-19 period was significantly associated with a higher rate of ACA (odds ratio [OR] = 1.87; 95% confidence interval [CI]: 1.23–2.52; P = 0.008) and longer length of hospital stay (OR= 2.10; 95% CI: 0.92 to 3.31; P < 0.001).Conclusions The COVID-19 pandemic was significantly associated with increased ACA rates in one community with a normal medical supply. The fear of being infected with COVID-19 may prohibit patients from seeking medical needs. To improve HSB during the pandemic, a surgical community should attempt to provide scientific information to the public and maintain surgical services under the coverage of workplace safety.