Surgical Intervention for Acute Cholecystitis Reduces Adverse Pregnancy Outcomes across trimesters

In a recent study assessing acute cholecystitis (AC) management during pregnancy, Mariam Hantouli and team found the delicate balance between surgical intervention and potential adverse pregnancy outcomes (APOs). The findings were published in Journal of American Medical Association.

The retrospective cohort study utilized data from the IBM MarketScan Commercial Claims and Encounters Database, spanning from 2007 to 2019. Involving 5759 pregnant individuals with AC and a matched cohort of 23,036 controls, this study aimed to evaluate the frequency of cholecystectomy during pregnancy and compare APO rates in those with and without AC. The results indicated that only 34.5% of pregnant individuals with AC underwent cholecystectomy during their pregnancy, with the lowest rate observed in the third trimester at 12.0%.

The study revealed that AC during pregnancy, irrespective of treatment, was associated with a higher risk of APOs, including preterm delivery and pregnancy loss. However, the receipt of surgery was linked to a lower odds ratio of APOs across all trimesters, with the greatest benefit observed in the third trimester.

These findings underscore the significance of adhering to guidelines recommending cholecystectomy during pregnancy and emphasize the potential to enhance outcomes for pregnant individuals with AC. The study's lead author highlighted the importance of increased guideline adherence and surgical intervention, particularly in the third trimester, as an opportunity to significantly improve outcomes for this population.

This research contributes to the ongoing dialogue on the management of AC during pregnancy, providing clinicians with valuable insights into the risks and benefits associated with surgical intervention. As medical professionals grapple with the complexities of treating AC in pregnant individuals, these results offer a crucial foundation for informed decision-making discussions and underscore the need for greater adherence to established guidelines.

Reference:

Hantouli, M. N., Droullard, D. J., Nash, M. G., Benson, L. S., Wright, A. S., Flum, D. R., & Davidson, G. H. (2023). Operative vs Nonoperative Management of Acute Cholecystitis During the Different Trimesters of Pregnancy. In JAMA Surgery. American Medical Association (AMA). https://doi.org/10.1001/jamasurg.2023.5803