{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:12:43Z","timestamp":1788502363426,"version":"build-2803163510"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute appendicitis remains a common surgical emergency. The COVID-19 pandemic severely impacted all the health systems globally including surgical emergencies management. This study aimed to assess changes in diagnosis and treatment of acute appendicitis in a tertiary emergency hospital serving an urban population before, during, and after the COVID-19 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a population-based cohort study including consecutive \u2265 18-year-old residents of a metropolitan area presenting with acute appendicitis at the tertiary emergency hospital. The study period between January 2018 and December 2023 was divided into: 2018-2019 (pre-COVID-19); 2020-2021 (COVID-19); 2022-2023 (post-COVID-19). Comparisons among the three periods were performed using one-way ANOVA and the Chi-square or Fisher's exact test as appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The breakdown of 1,721 patients included was: 662 in 2018-2019, 422 in 2020-2021, and 637 in 2022-2023. Although the catchment area population (1,817 vs. 1,799 vs. 1,781 MM;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.2), 27 surgeons (27 vs. 27 vs. 27), and 107,202 CT scans (32,048 vs. 38,806 vs. 36,348;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.716) were stable, colonoscopies significantly decreased in 2020-2021 (4,588 vs. 2,457 vs. 4,204;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012). The number of patients presenting with acute appendicitis decreased during the pandemic, with a relative increase in complicated cases. However, complication and mortality rates did not differ. The postoperative length of stay did not change significantly, despite the increased laparoscopic access rates. The appendiceal neoplasm rates were 2.4% in the COVID-19 and 1.9% in the post-COVID-19 year groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This six-year population-based study found a decreased number of patients presenting with acute appendicitis during the pandemic years, with a relative increase in complicated cases but no difference in mortality rates. The rates of appendiceal neoplasms raise concerns regarding the offering of conservative treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1919635","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:30:13Z","timestamp":1788499813000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute appendicitis before, during, and after the COVID-19 pandemic: a population-based cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Florin","family":"Iordache","sequence":"first","affiliation":[{"name":"Department of Surgery, Bucharest Emergency Hospital","place":["Bucharest, Romania"]},{"name":"Department of Surgery, University of Medicine and Pharmacy \u201cCarol Davila\u201c","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Lazar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Bucharest Emergency Hospital","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catalin","family":"Baraian","sequence":"additional","affiliation":[{"name":"Department of Surgery, Bucharest Emergency Hospital","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiberiu","family":"Giumba","sequence":"additional","affiliation":[{"name":"Department of Surgery, Bucharest Emergency Hospital","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Bergamaschi","sequence":"additional","affiliation":[{"name":"New York Colorectal Cancer Survivorship & Support Group, Jacobi Medical Center","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1016\/S2468-1253(24)00157-2","article-title":"Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the global burden of disease study 2021","volume":"9","year":"2024","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.2147\/JMDH.S327568","article-title":"Management of acute appendicitis during the COVID-19 pandemic is significantly different: a retrospective single UK hospital study","volume":"14","author":"Khan","year":"2021","journal-title":"J Multidiscip Healthc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e20202717","DOI":"10.1590\/0100-6991e-20202717","article-title":"Management of acute appendicitis during the COVID-19 pandemic: views of two Brazilian surgical societies","volume":"48","author":"Parreira","year":"2021","journal-title":"Rev Col Bras Cir"},{"key":"B4","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s00384-021-04031-4","article-title":"The impact of COVID-19 pandemic on the treatment of acute appendicitis in China","volume":"37","author":"Zheng","year":"2022","journal-title":"Int J Colorectal Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"820","DOI":"10.12998\/wjcc.v10.i3.820","article-title":"COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing: a single-center study","volume":"10","author":"Zhang","year":"2022","journal-title":"World J Clin Cases"},{"key":"B6","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1007\/s00384-021-04060-z","article-title":"The treatment of acute appendicitis in two age-based groups during COVID-19 pandemic: a retrospective experience in a COVID-19 referral hospital","volume":"37","author":"Lisi","year":"2022","journal-title":"Int J Colorectal Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e0263814","DOI":"10.1371\/journal.pone.0263814","article-title":"Did the severity of appendicitis increase during the COVID-19 pandemic?","volume":"17","author":"Chang","year":"2022","journal-title":"PLoS One"},{"key":"B8","doi-asserted-by":"publisher","first-page":"100512","DOI":"10.1016\/j.ijso.2022.100512","article-title":"Incidence of complicated appendicitis during the COVID-19 pandemic: a systematic review and meta-analysis","volume":"45","author":"Kariya","year":"2022","journal-title":"Int J Surg Open"},{"key":"B9","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1177\/00031348231204909","article-title":"Acute appendicitis in the epicenter of the COVID-19 pandemic: a New York city single-center experience","volume":"90","author":"Layrisse Landaeta","year":"2024","journal-title":"Am Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"482","DOI":"10.3892\/etm.2022.11409","article-title":"COVID-19-associated acute appendicitis in adults. 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