Adaptation of emergency surgical care during successive COVID-19 waves: a single-center analysis of surgically treated acute appendicitis

BACKGROUND: During the first wave of the COVID-19 pandemic, several studies - including our own - demonstrated a significant decrease in emergency surgical presentations, including acute appendicitis (AA). While these early findings are well documented, little is known about how presentation patterns and clinical outcomes evolved across subsequent pandemic waves. This study examines longer-term trends in AA care across three distinct pandemic phases, highlighting how healthcare systems and patient responses adapted over time within a tertiary surgical setting. METHODS: We conducted a retrospective single-center cohort study. Patients undergoing appendectomy between March 2020 and December 2021 were assigned to distinct pandemic phases based on national SARS-CoV-2 incidence (wave 2, wave 3, and wave 4). These were each compared separately to a pre-pandemic reference cohort treated between January 2019 and February 2020. Demographic data, clinical presentation, laboratory values, histological findings, and postoperative outcomes were analyzed. RESULTS: Throughout the pandemic period, the number of appendectomies remained lower than in the pre-pandemic reference group, particularly during high-incidence phases. Patients in wave 2 presented with more advanced disease, including significantly higher rates of perforation and peritonitis. In waves 3 and 4, disease severity and postoperative outcomes were comparable to the pre-pandemic reference period. CONCLUSION: This long-term analysis suggests that the initial shift toward more advanced disease among patients undergoing appendectomy was not sustained, with presentation patterns and outcomes tending toward pre-pandemic levels during later pandemic waves. These findings may reflect adaptive processes within the healthcare system, despite ongoing external stress.