key: cord-0979170-qofo355k authors: Chiu, Chong-Chi; Lee, Po-Huang; Lam, Chen-Fuh; Yeh, Li-Ren; Kwan Sun, Cheuk- title: A commentary on “Changes in appendicitis treatment during the COVID-19 pandemic - A systematic review and meta-analysis” (Int J Surg 2021;95:106,148) date: 2022-01-20 journal: Int J Surg DOI: 10.1016/j.ijsu.2022.106226 sha: 05c5e50cdc61769ceab8f93be5fdc8399ad7a1a1 doc_id: 979170 cord_uid: qofo355k nan We read with great interest the meta-analysis and systematic review by Köhler et al. [1] . The COVID-19 pandemic has transformed worldwide healthcare distribution and affected global surgical provision, with its impact on surgical workforce and hospitals' infrastructures. Modifications of management protocols and guidelines, together with introduction of novel practices, have been recommended to reduce the risk of infection and to ensure efficient allocation of available resources. One of the modified strategies to alleviate the pressure on healthcare system is to decrease hospitalization rate and postpone non-urgent surgeries. Although surgical intervention is still regarded as the gold standard for acute appendicitis (AA) management, a conservative non-operative approach in selected patients through administration of intravenous antibiotics as a first-line treatment has been well described. would encounter a lower complication-free recovery rate and a non-significantly higher rate of complicated appendicitis when surgical management was delayed due to initial antibiotic therapy. Therefore, we suggest that this alternative non-operative strategy could be safely used only in imaging confirmed uncomplicated AA with close monitoring and readily accessible medical counseling because of the risk of recurrence. Besides, the results of the two large APPAC II and III trials are expected to provide more reliable evidence regarding non-operative management [3] . 4.1 per cent did not take protective measures even for COVID-19-positive patients [5] . Conceivably, such phenomena may partly highlight the quagmire of a medical supply shortage during the pandemic. Based on the evidence of a decreased in demand of management of AA in adults and successful antibiotic management of well-selected patients with uncomplicated AA, resources can be reallocated from acute surgical services to other sectors with desperate needs. The findings mentioned above should be considered for any appropriate strategy planning and resource reassignment when confronted with the current Omicron wave. Not commissioned, externally peer-reviewed. Changes in appendicitis treatment during the COVID-19 pandemic -A systematic review and meta-analysis Acute appendicitis management during the COVID-19 pandemic: A prospective cohort study from a large UK centre Suspected appendicitis and COVID-19, a change in investigation and management-a multicentre cohort study Acute complex appendicitis during the COVID-19 epidemic: A single-institution retrospective analysis based on real-world data ACIE Appy Study Collaborative, Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study Unique Identifying number or registration ID: This is a commentary. No UIN is required Hyperlink to your specific registration (must be publicly accessible and will be checked): This is a commentary This is a commentary. No ethical approval is required. 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Please specify the contribution of each author to the paper, e.g. study design, data collections, data analysis, writing. Others, who have contributed in other ways should be listed as contributors. The Guarantor is the one or more people who accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Please note that providing a guarantor is compulsory. This is a commentary. No funding is required. This is a commentary. No ethical approval is required. This is a commentary. No UIN is required. This is a commentary. No ISRCTN is required. Commentary, internally reviewed. No primary research or confidential patient data was obtained due to the nature of this article. No data sets were generated or analyzed. There is no conflict of interest among authors.