Aim During the COVID-19 pandemic, emergency surgery was modified in line with Royal College guidance to accommodate the evolving climate . This study compared management of appendicitis before and during the pandemic by assessing disease presentation severity, modes of investigation, surgical management and patient outcomes . Outcomes assessed included length of stay, readmissions and rates of postoperative wound infections . Methods We collected data on appendicitis patients managed at a district general hospital over two distinct 8-week periods; 42 patients before and 36 patients during the COVID-19 pandemic respectively . The study included clinically or radiologically diagnosed appendicitis patients . Results Our study found patients during the COVID-19 pandemic had higher inflammatory markers (CRP 103 vs 53 mg/L; p = 0.03) and more severe disease on histological examination of the appendix than pre-pandemic . Patients were nearly twice as likely to undergo CT diagnosis of appendicitis during the pandemic than before . During the pandemic, only half of the cohort underwent laparoscopic appendicectomy in contrast with greater than 85% of the pre-COVID-19 cohort (p = 0.0005). Patients in the COVID-19 era cohort recorded shorter lengths of hospital stay (2.6 vs 3 days; p = 0.35); however, had higher reattendance rates (12 vs 25% ; p = 0.15) and surgical site infections (p = 0.0443). Finally, the study reported shorter median time to theatre (0 vs 1 days) during the pandemic than before . Conclusion In addition to reiterating the benefits of laparoscopic versus open surgery and quicker diagnostic methods, this study also implies that though patients during COVID-19 era presented with more severe disease, their treatment was in a more efficient service.