IMMEDIATE OPERATIVE MANAGEMENT OF COMPLICATED APPENDICITIS DURING PREGNANCY IS ASSOCIATED WITH IMPROVED OUTCOMES REGARDLESS OF TRIMESTER
Vincent Cheng*, Kazuhide Matsushima, Matthew Ashbrook, Kulmeet Sandhu, Koji Matsuo, Morgan Schellenberg, Kenji Inaba
General Surgery, Los Angeles County University of Southern California Medical Center, Los Angeles, CA
Immediate operative management for complicated appendicitis during pregnancy has been shown to be associated with improved clinical outcomes compared to non-operative management. However, the impact of pregnancy trimester has not been assessed in this context.
The National Inpatient Sample database was queried for all cases of complicated appendicitis during pregnancy between October 2015 and December 2017. Complicated appendicitis was defined as appendicitis with generalized peritonitis, perforation, or gangrene. Patients were categorized into three groups: non-operative management, failed non-operative management with delayed appendectomy (defined as surgical intervention >1 day after admission), and immediate operation. Univariate analysis was used to compare baseline patient and hospital characteristics. Multivariate regression analysis adjusted for differences in baseline patient and hospital characteristics to quantify the impact of management strategy and trimester on clinical outcomes.
A total of 80 pregnant women with complicated appendicitis satisfied inclusion criteria (1st trimester: 26%, 2nd trimester: 37%, 3rd trimester: 37%). Of these patients, 21% of patients underwent successful non-operative management, 26% failed non-operative management and underwent delayed appendectomy, and 53% underwent immediate surgery. The median age of all patients was 28 (interquartile range 24-32). None of the patients had a Charlson Comorbidity Index score of greater than 2. After controlling baseline patient and hospital characteristics, multivariate logistic regression showed that successful non-operative management was significantly associated with higher rates of maternal complications compared to immediate operative intervention (odds ratio [OR] 5.333, 95% confidence interval [CI] 1.038-27.392, p=0.45). Failed non-operative management requiring delayed surgery trended toward higher rates of maternal complications compared to immediate surgery (OR 3.911, 95% CI 0.784-19.519, p=0.096). Pregnancy trimester was not a significant predictor of maternal complications.
These results suggest that immediate operative management of complicated appendicitis during pregnancy is significantly associated with lower rates of maternal complications regardless of trimester.
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