Estimating the potential overdiagnosis and overtreatment of acute appendicitis in Thailand using a secondary data analysis of service utilization before, during and after the COVID-19 lockdown policy

PLoS One. 2022 Nov 3;17(11):e0270241. doi: 10.1371/journal.pone.0270241. eCollection 2022.

Abstract

Introduction: Acute appendicitis is one of the most common surgical emergencies; however, optimal diagnosis and treatment of acute appendicitis remains challenging. We used the coronavirus disease 2019 (COVID-19) lockdown policy as a natural experiment to explore potential overdiagnosis and overtreatment of acute appendicitis in Thailand. The aim of this study was to estimate the potential overdiagnosis and overtreatment of acute appendicitis in Thailand by examining service utilization before, during, and after the COVID-19 lockdown policy.

Methods: A secondary data analysis of patients admitted with acute appendicitis under the Universal Coverage Scheme (UCS) in Thailand over a 6-year period between 2016 and 2021 was conducted. The trend of acute appendicitis was plotted using a 14-day rolling average of daily cases. Patient characteristics, clinical management, and outcomes were descriptively presented and compared among three study periods, namely pre-pandemic, lockdown, and post-lockdown.

Results: The number of overall acute appendicitis cases decreased from 25,407 during pre-pandemic to 22,006 during lockdown (13.4% reduction) and 21,245 during post-lockdown (16.4% reduction). This reduction was mostly due to a lower incidence of uncomplicated acute appendicitis, whereas cases of generalized peritonitis were scarcely affected by the pandemic. There was an increasing trend towards the usage of diagnostic computerized tomography for acute appendicitis but no significant difference in treatment modalities and complication rates.

Conclusion: The stable rates of generalized peritonitis and complications during the COVID-19 lockdown, despite fewer admissions overall, suggest that there may have been overdiagnosis and overtreatment of acute appendicitis in Thailand. Policy makers could use these findings to improve clinical practice for acute appendicitis in Thailand and support the efficient utilization of surgical services in the future, especially during pandemics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Appendectomy
  • Appendicitis* / diagnosis
  • Appendicitis* / epidemiology
  • Appendicitis* / surgery
  • COVID-19* / epidemiology
  • Communicable Disease Control
  • Data Analysis
  • Humans
  • Overdiagnosis
  • Overtreatment
  • Peritonitis*
  • Policy
  • Retrospective Studies
  • Thailand / epidemiology

Grants and funding

The Health Intervention and Technology Assessment Program (HITAP) is a semi-autonomous research unit in the Ministry of Public Health, Thailand, and supports evidence-informed priority-setting and decision-making for healthcare. HITAP is funded by national and international public funding agencies. HITAP’s international work is supported by the International Decision Support Initiative (iDSI), with the aim of providing technical assistance on health intervention and technology assessment to governments in low-income and middle-income countries. iDSI is funded by the Bill & Melinda Gates Foundation (OPP1202541), the UK’s Department for International Development, the Rockefeller Foundation. HITAP is also supported by the Access and Delivery Partnership, which is hosted by the United Nations Development Programme and funded by the Government of Japan. This study is also funded by the Health Systems Research Institute (HSRI), Thailand (64281002RM002L0). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The findings, interpretations and conclusions expressed in this article do not necessarily reflect the views of the funding agencies.