Intra-abdominal infections are the second most common source of severe sepsis and successful treatment relies on early intervention and appropriate resources.1–3 The COVID-19 pandemic has disrupted the global healthcare system as evidenced by a national study in England showing reduced admissions and higher 90-day mortality for common acute surgical conditions.4 5 We examined intra-abdominal infection-related mortality trends from 1999 to 2021, which encompasses the COVID-19 pandemic.

Using the National Vital Statistics System (NVSS) database (1999–2021), which registers more than 99% of deaths in the USA, we obtained decedents with intra-abdominal infection, defined as deaths related to acute cholecystitis, acute appendicitis, Clostridioides difficile colitis, diverticulitis or pyelonephritis (multiple causes were possible). Age-standardised mortality rates (ASMR) per 100 000 population were calculated using the 2010 US Census as the standard population. Joinpoint Regression Program (V.4.9.0.0) was performed to evaluate ASMR trends overall and stratified by age groups: young age (25–44), middle age (45–64) and the elderly (≥65) (online supplemental file 1). Forecast analysis was conducted to predict annual ASMR in 2020 and 2021 from intra-abdominal infections based …