Immediate surgery preferred strategy for complicated appendicitis among pregnant women: JAMA

Data are sparse regarding the optimal treatment for complicated appendicitis during pregnancy. A study was conducted to compare nonoperative and operative management in complicated appendicitis during pregnancy. This cohort study was conducted using National Inpatient Sample data from between January 2003 and September 2015. This database approximates a 20% stratified sample of US inpatient hospital discharges. Included individuals were pregnant women discharged with the diagnosis of complicated appendicitis. Data were analyzed from February 2020 through February 2022.

Study patients were categorized into 3 groups: those with successful nonoperative management, failed nonoperative management with delayed operation, or immediate operation for complicated appendicitis. Clinical outcomes, including maternal infectious complications and perinatal complications, hospital length of stay, and total hospital charges.

The results of the study are:

• Among 8087 pregnant women with complicated appendicitis, nonoperative management of complicated appendicitis was successful among 954 patients (11.8%) and failed among 2646 patients (32.7%), who underwent delayed operation; 4487 patients (55.5%) underwent an immediate operation.
• In multivariate analysis, successful nonoperative management was associated with higher odds of amniotic infection and sepsis compared with the immediate operation, while there was no significant difference in preterm delivery, preterm labour, or abortion.
• However, failed nonoperative management that required delayed operation was associated with higher odds of preterm delivery, preterm labour, or abortion compared with immediate operation
• An immediate operation was associated with decreased hospital charges compared with nonoperative management that was successful and that failed
• In subgroup multivariate logistic regression analysis, each day in a delay to surgery was associated with an increase in odds of preterm delivery, preterm labour, or abortion by 23%

Thus, this study found that immediate operation for complicated appendicitis in pregnant women was associated with lower odds of maternal infectious complications without higher odds of perinatal or other maternal complications compared with successful nonoperative management. Failed non-operative management was associated with worse clinical outcomes.

Reference:

Management of Complicated Appendicitis During Pregnancy in the US by Matthew Ashbrook, et al. published in the JAMA Network Open.

doi:10.1001/jamanetworkopen.2022.7555