Impact of COVID-19 on appendicitis presentations in children in Australia and New Zealand

ANZ J Surg. 2022 Apr;92(4):736-741. doi: 10.1111/ans.17566. Epub 2022 Mar 13.


Background: In contrast to many countries, the prevalence of COVID-19 in Australia and New Zealand has been low. We hypothesised, however, that a potential secondary effect of the COVID-19 pandemic would be delayed presentation of paediatric appendicitis, with resultant higher rates of complicated appendicitis. This study was an initiative of the Australian and New Zealand Surgery in Children Registrars' Association for Trials collaborative, a trainee-led research group based in Australia and New Zealand.

Methods: A binational multicentre, retrospective review was undertaken of paediatric patients with appendicitis early in the COVID-19 pandemic (20 March-30 April 2020), compared with previous years (2018, 2019). Primary outcomes were the duration of symptoms prior to presentation and the severity of disease.

Results: A total of 400 patients from six centres were included. Duration of symptoms prior to presentation, sepsis at presentation, complicated disease and presence of complications did not differ significantly between time periods. Duration of intravenous antibiotic treatment and overall antibiotic treatment were both significantly shorter during 2020 (2.4 days versus 3.5 in 2018 and 3.0 in 2019 [P = 0.0038] and 3.7 days versus 5.2 in 2018 and 4.6 in 2019 [P = 0.04], respectively). Management approach did not differ, with the majority of patients managed operatively.

Conclusions: We did not demonstrate any difference in duration of symptoms prior to presentation or other markers of disease severity early in the pandemic. Duration of antibiotic treatment was shorter during this period compared with previous years. Management of children with appendicitis, both simple and complicated, did not appear to change as a result of COVID-19.

Keywords: COVID-19; appendicitis; paediatric surgery; perforated appendicitis.

Publication types

  • Multicenter Study

MeSH terms

  • Anti-Bacterial Agents
  • Appendectomy
  • Appendicitis* / diagnosis
  • Appendicitis* / epidemiology
  • Appendicitis* / surgery
  • Australia / epidemiology
  • COVID-19* / epidemiology
  • Child
  • Humans
  • New Zealand / epidemiology
  • Pandemics
  • Retrospective Studies
  • SARS-CoV-2


  • Anti-Bacterial Agents