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TREATMENT PREFERENCES FOR ACUTE UNCOMPLICATED APPENDICITIS DURING PREGNANCY: A QUALITATIVE STUDY AT A LARGE SAFETY NET HOSPITAL
Brynne A. Ichiuji
*, Elizabeth B. Sasso, Priscilla M. Garza, Laurel S. Aberle, Claire Therriault, Koji Matsuo, Anaar Siletz, Matthew Martin, Kenji Inaba, Kazuhide Matsushima
Surgery, University of Southern California, Los Angeles, CA
Background
The management of acute appendicitis during pregnancy remains a topic of debate, where both operative and non-operative options carry distinct risks and benefits. Due to the challenges in conducting randomized controlled trials including pregnant patients, there is limited high-quality evidence to guide treatment decisions. This study seeks to explore how pregnant patients would make decisions regarding the treatment of acute uncomplicated appendicitis, with the goal of enhancing shared decision-making and empowering patients to make informed choices.
Methods
We conducted semi-structured interviews with currently pregnant or recently postpartum patients attending the perinatal clinic at one of the largest county hospitals in the US. Participants completed a demographic survey and then took part in an interview, where they were asked about their treatment preferences for acute uncomplicated appendicitis both before and after receiving detailed counseling of the risks and benefits of operative and non-operative options. The transcriptions were analyzed using ATLAS.ti software for qualitative thematic analysis. Responses were coded to identify themes related to patient preferences, considerations, and decision-making factors.
Results
There were 30 patients interviewed with a median age of 30.3 years [IQR: 25-36 years]. 60% of participants identified their race/ethnicity as Hispanic, 16.7% as Black, 6.7% as White, and 3.3% as Asian. Most participants (63.3%) had completed high school, 70% were homemakers, and 33.3% reported an annual household income of less than $10,000. 70% of the patients were pregnant while 30% of patients were postpartum, with 57.1% of the pregnant cohort experiencing their first pregnancy. Prior to detailed risk/benefit counseling, half of the participants strongly preferred operative management. Following counseling, two-thirds of those patients changed their decision to antibiotics after presentation of the actual risks and benefits of both options. Conversely, 13.3% of the patients who initially chose non-operative management changed their decision to operative management post-counseling. The most common factors informing decision-making were concerns about fetal health, maternal health, fear of surgery, concerns about return to work, concerns about childcare, and fear of hospitalization (Table 1, Figure 1).
Conclusion
This study highlights the complexity of treatment decision-making for acute uncomplicated appendicitis during pregnancy, with patient preferences shaped by a combination of medical, emotional, and practical considerations. Informed risk-benefit discussions can significantly alter treatment preferences. Future research should focus on strategies to empower patients in making informed, individualized decisions.
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