Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study

Brittany Hegde, Elisa Garcia, Andrew Hu, Mehul Raval, Sanyu Takirambudde, Derek Wakeman, Ruth Lewit, Ankush Gosain, Raphael H. Parrado, Robert A. Cina, Krista Stephenson, Melvin S. Dassinger, Daniel Zhang, Moiz M. Mustafa, Donna Koo, Aaron M. Lipskar, Katherine Scheidler, Kyle J. Van Arendonk, Patrick Berg, Raquel GonzalezDaniel Scheese, Jeffrey Haynes, Alexander Mina, Irving J. Zamora, Monica E. Lopez, Steven C. Mehl, Elizabeth Gilliam, Katrina Lofberg, Brianna Spencer, Afif N. Kulaylat, Brian C. Gulack, Matthew Johnson, Matthew Laskovy, Pavan Brahmamdam, Aoi Shimomura, Therese Blanch, Kuo Jen Tsao, Bethany J. Slater*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes. Methods: A multicenter retrospective study was performed including 19 children's hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis. Groups were defined by each hospital's city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed. Results: Of 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More patients were managed non-operatively during the COVID-19 pandemic compared to before the pandemic (147 (6.1%) vs 144 (4.0%), p < 0.001). Despite this change, there was no difference in the proportion of complicated appendicitis between groups (1,247 (34.6%) vs 849 (35.2%), p = 0.12). COVID era non-operative patients received fewer additional procedures, including interventional radiology (IR) drain placements, compared to pre-COVID non-operative patients (29 (19.7%) vs 69 (47.9%), p < 0.001). On adjusted analysis, factors associated with increased odds of receiving non-operative management included: increasing duration of symptoms (OR=1.01, 95% CI: 1.01–1.012), African American race (OR=2.4, 95% CI: 1.3–4.6), and testing positive for COVID-19 (OR=10.8, 95% CI: 5.4–21.6). Conclusion: Non-operative management of appendicitis increased during the COVID-19 pandemic. Additionally, fewer COVID era cases required IR procedures. These changes in the management of pediatric appendicitis during the COVID pandemic demonstrates the potential for future utilization of non-operative management.

Original languageEnglish (US)
Pages (from-to)1375-1382
Number of pages8
JournalJournal of pediatric surgery
Issue number7
StatePublished - Jul 2023


  • COVID-19
  • Non-operative management
  • Patient outcomes
  • Pediatric appendicitis
  • SARS-CoV-2
  • Stay at home order

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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