Immediate Surgery for Complicated Appendicitis in Pregnancy Linked to Better Outcomes

October 13, 2020

By Nancy Melville

YORK, Me -- October 9, 2020 -- Pregnant women who develop complicated appendicitis show significantly better outcomes when treated with immediate surgery rather than nonsurgical management or delayed surgery after nonsurgical management fails, according to a study presented at the 2020 Virtual Meeting of the American College of Surgeons (ACS).

“Immediate surgery for acute complicated appendicitis during pregnancy is significantly associated with lower rates of infectious outcomes, shorter hospital stays, and lower costs compared with medical management,” said Vincent Cheng, MD, Keck School of Medicine, University of Southern California, Los Angeles, California. “Every day of delay to surgery means worse clinical outcomes for the patient as well as the fetus.”

For the study, the researchers analysed data from the National Inpatient Sample (2003 to 2015) and identified 1,704 pregnant women with complicated appendicitis (median age, 27 years). Of the patients, 949 had surgery immediately, 197 were successfully managed without surgery, and 558 failed nonsurgical management and had a delayed appendectomy, either minimally invasive or open.

Compared with those who had immediate surgery, women who were successfully treated with medical management had no significant differences in rates of preterm delivery, preterm labour, or abortion. However, medical management was significantly associated with higher rates of complications, including amniotic infection (odds ratio [OR] = 4.354; P P = .011). Patients requiring delayed surgery after failing medical management had significantly higher rates of fetal loss than those who had immediate surgery (OR = 1.447; P

Hospital costs were significantly lower for patients who had immediate surgery than for those who had successful (regression coefficient [RC] = 0.092; PP

“Every situation is different and every patient is different, so the discussion about how to manage this disease process should be a joint process between the patient and the surgeon that presents the pros and cons of the treatment options,” Dr. Cheng concluded.

[Presentation title: Management of Complicated Appendicitis During Pregnancy: A Nationwide Analysis]