Reply to: ‘global attitudes in the management of acute appendicitis during COVID‐19 pandemic: ACIE Appy study’

Dear Editor

As part of a global survey, Ielpo B et al¹ collected the attitudes of surgeons toward the management of acute appendicitis, in the initial period of the COVID-19 pandemic.

We commend the reach of this study and agree that respondents in countries where the pandemic was in the early stages underestimated the real impact of COVID-19 on emergency surgery. Caution, however, should be taken when interpreting these results, treatment options adopted changed regionally, as the number of COVID-19 infections spread, as well as the availability of PPE.

The study was conducted when evidence regarding the effects of the COVID-19 associated risks with operative surgery on routine emergency procedures was limited. The attitude toward management of appendicitis has changed significantly during the pandemic. Surgeons became more comfortable with a non-operative management approach, with an increase from 6.6 per cent to 23.7 per cent. The study did not question the changes in diagnostic methodology. We note that CT thorax was employed by some centres as a screening tool for COVID-19, and surmise that this modality was also used more frequently to provide a clear diagnosis compared to diagnostic laparoscopy.

Innovation often prospers when overcoming adversity. The pandemic has brought forward many new approaches to treat common conditions. Embracing these changes may allow us to develop novel methods to improve patient management and care for the future.

Same day management of acute appendicitis can reduce the length of stay, enhancing patient experience, as well as promoting optimal bed capacity. Adopting a culture of using scoring systems, during clinical assessment, and in conjunction with sensitive radiological imaging, will confidently identify appendicitis and facilitate use of an emergency ambulatory operating service.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

This article is not based on any previous communication to a society or meeting.

Disclosure. No conflict of interest declared.