Background During the first United Kingdom COVID-19 wave, the Royal Colleges of Surgeons initially recommended conservative management with antibiotics instead of surgery for appendicitis . This study compared local outcomes of appendicitis during this period with a pre-COVID-19 cohort . Methods An observational study was conducted in a district general hospital . All episodes of appendicitis were prospectively studied from 25th March 2020 until 26th May 2020 and compared with a retrospective pre-COVID cohort from 27th November 2019 until 29th January 2020 . Primary outcome was 30-day treatment failure of simple appendicitis for conservatively managed cases during COVID-19 compared to surgically managed cases pre-pandemic . Treatment failure was defined as any unplanned radiological or surgical intervention . Results Over nine weeks, there were 39 cases of appendicitis during COVID-19 and 50 cases pre-COVID-19 . Twenty-six and 50 cases underwent appendicectomy during and pre-COVID-19 respectively . There was no difference in 30-day postoperative complication rates and nor were there any peri-operative COVID-19 infections . Twelve cases of simple appendicitis underwent conservative management during COVID-19 and were compared with 23 operatively managed simple cases pre-pandemic . There was a higher failure rate in the conservative versus operative group (33.3 vs 0% OR = 24.88 , 95% CI 1.21 to 512.9, p=0.0095). Length of stay was similar (1.5 vs 2.0 p=0.576). Discussion Locally, conservative management was more likely to fail than initial appendicectomy . We suggest that surgery should remain first line for appendicitis, with conservative management reserved for those with suspected or proven COVID-19 infection.