N Abbasi1, V Patenaude, H A Abenhaim. 1. Department of Obstetrics and Gynaecology, Jewish General Hospital, Montreal, QC, Canada.
Abstract
OBJECTIVE: To compare outcomes and management practices among pregnant and nonpregnant women with acute appendicitis. DESIGN: Population-based matched cohort study. SETTING: United States of America. SAMPLE: A total of 7114 women with appendicitis among 7,037,386 births. METHODS: Logistic regression analyses to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables and outcomes of interest. MAIN OUTCOME MEASURES: Maternal morbidities associated with appendicitis; management practices for pregnant and age-matched nonpregnant women with appendicitis. RESULTS: There was an overall incidence of 101.1 cases of appendicitis per 100,000 births. Appendicitis was diagnosed in 35,570 nonpregnant women during the corresponding time frame. Peritonitis occurred in 20.3% of pregnant women with appendicitis, with an adjusted OR of 1.3 (95% CI 1.2-1.4) when compared with nonpregnant women with appendicitis. In pregnancy, there was an almost two-fold increase in sepsis and septic shock, transfusion, pneumonia, bowel obstruction, postoperative infection and length of stay >3 days. Whereas 5.8% of appendicitis cases among pregnant women were managed conservatively, they were associated with a considerably increased risk of shock, peritonitis and venous thromboembolism as compared to surgically managed cases. CONCLUSIONS: Compared with nonpregnant women, pregnant women with acute appendicitis have higher rates of adverse outcomes. Conservative management should be avoided given the serious risk of adverse outcomes in pregnancy.
OBJECTIVE: To compare outcomes and management practices among pregnant and nonpregnant women with acute appendicitis. DESIGN: Population-based matched cohort study. SETTING: United States of America. SAMPLE: A total of 7114 women with appendicitis among 7,037,386 births. METHODS: Logistic regression analyses to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables and outcomes of interest. MAIN OUTCOME MEASURES: Maternal morbidities associated with appendicitis; management practices for pregnant and age-matched nonpregnant women with appendicitis. RESULTS: There was an overall incidence of 101.1 cases of appendicitis per 100,000 births. Appendicitis was diagnosed in 35,570 nonpregnant women during the corresponding time frame. Peritonitis occurred in 20.3% of pregnant women with appendicitis, with an adjusted OR of 1.3 (95% CI 1.2-1.4) when compared with nonpregnant women with appendicitis. In pregnancy, there was an almost two-fold increase in sepsis and septic shock, transfusion, pneumonia, bowel obstruction, postoperative infection and length of stay >3 days. Whereas 5.8% of appendicitis cases among pregnant women were managed conservatively, they were associated with a considerably increased risk of shock, peritonitis and venous thromboembolism as compared to surgically managed cases. CONCLUSIONS: Compared with nonpregnant women, pregnant women with acute appendicitis have higher rates of adverse outcomes. Conservative management should be avoided given the serious risk of adverse outcomes in pregnancy.
Authors: Jonathan P Pearl; Raymond R Price; Allison E Tonkin; William S Richardson; Dimitrios Stefanidis Journal: Surg Endosc Date: 2017-06-22 Impact factor: 4.584
Authors: Adam Sachs; Jean Guglielminotti; Russell Miller; Ruth Landau; Richard Smiley; Guohua Li Journal: JAMA Surg Date: 2017-05-01 Impact factor: 14.766