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Pregnant patients requiring appendectomy: comparison between open and laparoscopic approaches in NY State

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Even though acute appendicitis is the most common general surgical condition encountered during pregnancy, the preferred approach to appendectomy in pregnant patients remains controversial. Current guidelines support laparoscopic appendectomy as the treatment of choice for pregnant women with appendicitis, regardless of trimester. However, recent published data suggests that the laparoscopic approach contributes to higher rates of fetal demise. Our study aims to compare laparoscopic and open appendectomy in pregnancy at a statewide population level.

Methods

ICD-9 codes were used to extract 1006 pregnant patients undergoing appendectomy between 2005 and 2014 from the NY Statewide Planning and Research Cooperative System (SPARCS) database. Surgical outcomes (any complications, 30-day readmission rate, length of stay (LOS)) and obstetrical outcomes (antepartum hemorrhage, preterm delivery, cesarean section, sepsis, chorioamnionitis) were compared between open and laparoscopic appendectomy. Multivariable generalized linear regression models were used to compare different outcomes between two surgical approaches after adjusting for possible confounders.

Results

The laparoscopic cohort (n = 547, 54.4%) had significantly shorter LOS than the open group (median ± IQR: 2.00 ± 2.00 days versus 3.00 ± 2.00 days, p value < 0.0001, ratio = 0.789, 95% CI 0.727–0.856). Patients with complicated appendicitis had longer LOS than those with simple appendicitis (p value < 0.0001, ratio = 1.660, 95% CI 1.501–1.835). Obstetrical outcomes (p value = 0.097, OR 1.254, 95% CI 0.961–1.638), 30-day non-delivery readmission (p value = 0.762, OR 1.117, 95% CI 0.538–2.319), and any complications (p value = 0.753, OR 0.924, 95% CI 0.564–1.517) were not statistically significant between the laparoscopic versus open appendectomy groups. Three cases of fetal demise occurred, all within the laparoscopic appendectomy group.

Conclusions

The laparoscopic approach resulted in a shorter LOS. Although fetal demise only occurred in the laparoscopic group, these results were not significant (p value = 0.255). Our large population-based study further supports current guidelines that laparoscopic appendectomy may offer benefits over open surgery for pregnant patients in any trimester due to reduced time in the hospital and fetal and maternal outcomes comparable to open appendectomy.

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Acknowledgements

We acknowledge the biostatistical consultation and support from the Biostatistical Consulting Core at the School of Medicine, Stony Brook University.

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Author notes

  1. Jared Su and Christine A. Ward have contributed equally this work.

Authors and Affiliations

  1. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA

    Abhinay Tumati, Jared Su, Christine A. Ward, Julie Hong, Konstantinos Spaniolas, Mark A. Talamini & Aurora D. Pryor

  2. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    Jie Yang & Xiaoyue Zhang

  3. Department of Obstetrics, Gynecology, and Reproductive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    David Garry

  4. Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA

    Abhinay Tumati

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  1. Abhinay Tumati
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Correspondence to Abhinay Tumati.

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Disclosures

No industry or other external funding was used for this research. Dr. Pryor is a speaker for Ethicon, Gore, Merck, and Stryker. She participates on a scientific advisory board for Obalon. Dr. Spaniolas has research support from Merck and is a speaker for Gore. Ms. Zhang, Dr. Tumati, Dr. Yang, Dr. Su, Dr. Ward, Dr. Hong, Dr. Garry, and Dr. Talamini have no conflicts of interest or financial ties to disclose.

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Tumati, A., Yang, J., Zhang, X. et al. Pregnant patients requiring appendectomy: comparison between open and laparoscopic approaches in NY State. Surg Endosc 35, 4681–4690 (2021). https://doi.org/10.1007/s00464-020-07911-y

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  • DOI: https://doi.org/10.1007/s00464-020-07911-y

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