Background
Little is known about how COVID-19 impacted acute surgical activity for children and young people (CYP) across England. Appendicitis and testicular torsion are common surgical conditions where treatment delays can lead to avoidable complications. We undertook a retrospective national cohort study.

Primary aim
To describe monthly acute surgical activity in CYP during the pandemic.

Secondary aim
To investigate evidence of delayed diagnosis and adverse outcomes, describing variations by age and deprivation.

Methods
Acute admissions with appendicitis or testicular pain for under-18s were extracted using Hospital Episode Statistics. Interrupted time series modelling, Mann-Whitney and Pearson’s Chi-Squared tests compared the first 14 pandemic months with the previous five years. Results were stratified by age (0-4s, 5-9s and 10-17s) and appendicitis type (all, simple and complex).

Results
Admissions for appendicitis and testicular torsion fell significantly early in the pandemic. The proportion of children with complex appendicitis also increased during this time. Orchidectomy rates rose in April 2020 for the 0-4s (+15.6% (7.9 to 23.3)) and 10-17s (+11.5% (4.9 to 18.2)), but when the pre-pandemic period was compared with the pandemic period as a whole, there were no overall statistically significant differences in orchidectomy rates between the study periods. Overall, there was a statistically significant rise in the orchidopexy rate during the pandemic period for the 10-17s when compared with the pre-pandemic period (Pre-pandemic: 17.0% vs Pandemic: 20.9%, p<0.0001).

Conclusion
A consistent reduction in activity, with short-lived periods of delayed presentations during pandemic peaks, occurred without persisting overall increased complication rates. These results provide useful national context for smaller sized studies that reported complications due to delays in surgery. Future research could examine how reduced activity impacted other healthcare settings and treatment pathways.

Level of evidence
II