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Appendectomy in Third Trimester of Pregnancy and Birth Outcomes: A Propensity Score Analysis of a 6-Year Cohort Study Using Administrative Claims Data

  • Surgery in Low and Middle Income Countries
  • Published:
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Abstract

Introduction

While there is evidence of obstetric and neonatal outcomes from non-obstetric surgery during pregnancy, surgery during the third trimester of gestation has not been evaluated as a prognostic factor for those outcomes. The objective of this study was to determine whether appendectomies during the third trimester are associated with adverse neonatal outcomes, in comparison with appendectomies during the first two trimesters, based on national administrative data in Colombia.

Methods

A retrospective cohort study was performed using administrative health records. It included all women who had live births and who underwent an appendectomy during any stage of pregnancy, between the years 2011 and 2016, and who belonged to Colombia’s contributory health system. The main outcome was preterm birth. Birth weight and 1-min and 5-min Apgar scores were also measured, as well as outcomes used to identify neonatal near-miss cases. Propensity score matching was used in order to balance baseline characteristics (age, weeks of gestation, obstetric comorbidity index, and region and year the procedure was performed). Relative risks were estimated with Poisson regressions.

Results

This study included a total of 2507 women in Colombia’s contributory health system who underwent an appendectomy during pregnancy. Appendectomy was performed on 885 women (35.30%) in their first trimester, 1205 women (48.07%) in their second trimester, and 417 women (16.63%) in their third trimester. For the entire population, the preterm birth rate was 11.85 per 100 appendectomies. With the matched sample, this study found that women in their third trimester had a 1.65 greater risk of preterm birth [95% CI, 1.118–2.423], a 3.43 greater risk of birth at gestational ages < 33 weeks [95% CI, 1.363 to 8.625], 2.083 greater risk of weight under 1750 g [95% CI, 1.056–4.109], and a mean difference of − 0.247 [95% CI, − .382 to − .112] in the 1-min Apgar score and − .168a [95% CI, − .276 to − .060] in the 5-min Apgar. No differences were found in birth weight or Apgar scores < 7.

Conclusions

In Colombia’s contributory health system, women who undergo appendectomies in their third trimester have a greater risk of preterm birth, birth weight under 1750 g, birth at gestational ages less than 33 weeks, and decreased 1-min and 5-min Apgar scores.

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References

  1. Pearl J, Price R, Richardson W, Fanelli R (2011) Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 25(11):3479. https://doi.org/10.1007/s00464-011-1927-3

    Article  PubMed  Google Scholar 

  2. Augustin G, Majerovic M (2007) Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol 131(1):4–12. https://doi.org/10.1016/j.ejogrb.2006.07.052

    Article  PubMed  Google Scholar 

  3. Barber-Millet S, Bueno Lledó J, Granero Castro P, Gómez Gavara I, Ballester Pla N, García Domínguez R (2016) Update on the management of non-obstetric acute abdomen in pregnant patients. Cirugía Española (English Ed) 94(5):257–265. https://doi.org/10.1016/j.cireng.2016.05.001

    Article  Google Scholar 

  4. Chawla S, Vardhan S, Jog SS (2003) Appendicitis during pregnancy. Med J Armed Forces India 59(3):212–215. https://doi.org/10.1016/S0377-1237(03)80009-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lotfipour S, Jason M, Liu VJ et al (2018) Latest considerations in diagnosis and treatment of appendicitis during pregnancy. Clin Pract Cases Emerg Med. https://doi.org/10.5811/cpcem.2018.1.36218

    Article  PubMed  PubMed Central  Google Scholar 

  6. Aggenbach L, Zeeman GG, Cantineau AEP, Gordijn SJ, Hofker HS (2015) Impact of appendicitis during pregnancy: no delay in accurate diagnosis and treatment. Int J Surg 15:84–89. https://doi.org/10.1016/j.ijsu.2015.01.025

    Article  CAS  PubMed  Google Scholar 

  7. Behrman RE, Butler AS, Outcomes I of M (US) C on UPB and AH (2007) Committee on understanding premature birth and assuring healthy outcomes. National Academies Press, New York

    Google Scholar 

  8. Saigal S, Hoult LA, Streiner DL, Stoskopf BL, Rosenbaum PL (2000) School difficulties at adolescence in a regional cohort of children who were extremely low birth weight. Pediatrics 105(2):325–331. https://doi.org/10.1542/peds.105.2.325

    Article  CAS  PubMed  Google Scholar 

  9. Behrman RE, Butler AS, Outcomes I of M (US) C on UPB and AH (2007) Societal costs of preterm birth. National Academies Press, New York

    Google Scholar 

  10. Frey HA, Klebanoff MA (2016) The epidemiology, etiology, and costs of preterm birth. Semin Fetal Neonatal Med 21(2):68–73. https://doi.org/10.1016/j.siny.2015.12.011

    Article  PubMed  Google Scholar 

  11. Vogel JP, Chawanpaiboon S, Watananrun K et al (2016) Global, regional and national levels and trends of preterm birth rates for 1990 to 2014: protocol for development of World Health Organization estimates. Reprod Health 13:76. https://doi.org/10.1186/s12978-016-0193-1

    Article  PubMed  PubMed Central  Google Scholar 

  12. Balinskaite V, Bottle A, Sodhi V et al (2017) The risk of adverse pregnancy outcomes following nonobstetric surgery during pregnancy: estimates from a retrospective cohort study of 6.5 million pregnancies. Ann Surg 266(2):260. https://doi.org/10.1097/SLA.0000000000001976

    Article  Google Scholar 

  13. OECD (2015) OECD reviews of health systems: Colombia 2016. OECD. https://www.oecd-ilibrary.org/social-issues-migration-health/oecd-reviews-of-health-systems-colombia-2015_9789264248908-en

  14. Merlano-Porras CA, Gorbanev I (2013) Health system in Colombia: a systematic review of literature. Rev Gerency Políticas Salud 12(24):74–86.

  15. Althabe F, Howson CP, Kinney M, Lawn J, World Health Organization. Born Too Soon: the Global Action Report on Preterm Birth.

  16. Pileggi-Castro C, Camelo JS Jr, Perdoná GC et al (2014) Development of criteria for identifying neonatal near-miss cases: analysis of two WHO multicountry cross-sectional studies. BJOG An Int J Obstet Gynaecol 121(s1):110–118. https://doi.org/10.1111/1471-0528.12637

    Article  Google Scholar 

  17. Bateman BT, Mhyre JM, Hernandez-Diaz S et al (2013) Development of a comorbidity index for use in obstetric patients. Obstet Gynecol 122(5):957–965. https://doi.org/10.1097/AOG.0b013e3182a603bb

    Article  PubMed  Google Scholar 

  18. Metcalfe A, Lix L, Johnson J-A et al (2015) Validation of an obstetric comorbidity index in an external population. BJOG An Int J Obstet Gynaecol 122(13):1748–1755. https://doi.org/10.1111/1471-0528.13254

    Article  CAS  Google Scholar 

  19. Abadie A, Imbens GW (2016) Matching on the estimated propensity score. Econometrica 84(2):781–807. https://doi.org/10.3982/ECTA11293

    Article  Google Scholar 

  20. Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28(25):3083–3107. https://doi.org/10.1002/sim.3697

    Article  PubMed  PubMed Central  Google Scholar 

  21. Knol MJ, Le Cessie S, Algra A, Vandenbroucke JP, Groenwold RHH (2012) Overestimation of risk ratios by odds ratios in trials and cohort studies: alternatives to logistic regression. CMAJ 184(8):895–899. https://doi.org/10.1503/cmaj.101715

    Article  PubMed  PubMed Central  Google Scholar 

  22. Behnke M, Carter R, Hardt N, Eyler F, Cruz A, Resnick M (1987) The relationship of apgar scores, gestational age, and birthweight to survival of low-birthweight infants. Am J Perinatol 4(02):121–124. https://doi.org/10.1055/s-2007-999752

    Article  CAS  PubMed  Google Scholar 

  23. Andersen B, Nielsen TF (1999) Appendicitis in pregnancy, diagnosis, management and complications. Acta Obstet Gynecol Scand 78(9):758–762. https://doi.org/10.1034/j.1600-0412.1999.780903.x

    Article  CAS  PubMed  Google Scholar 

  24. Zingone F, Sultan AA, Humes DJ, West J (2015) Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England. Ann Surg 261(2):332–337. https://doi.org/10.1097/SLA.0000000000000780

    Article  PubMed  Google Scholar 

  25. Walsh CA, Tang T, Walsh SR (2008) Laparoscopic versus open appendicectomy in pregnancy: a systematic review. Int J Surg 6(4):339–344. https://doi.org/10.1016/j.ijsu.2008.01.006

    Article  PubMed  Google Scholar 

  26. Frountzas M, Nikolaou C, Stergios K, Kontzoglou K, Toutouzas K, Pergialiotis V (2019) Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies. Ann R Coll Surg Engl 101(4):235–248. https://doi.org/10.1308/rcsann.2019.0011

    Article  CAS  PubMed  Google Scholar 

  27. Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A (2012) Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg 99(11):1470–1478. https://doi.org/10.1002/bjs.8889

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Walker HGM, Al Samaraee A, Mills SJ, Kalbassi MR (2014) Laparoscopic appendicectomy in pregnancy: a systematic review of the published evidence. Int J Surg 12(11):1235–1241. https://doi.org/10.1016/j.ijsu.2014.08.406

    Article  PubMed  Google Scholar 

  29. Prodromidou A, Machairas N, Kostakis ID et al (2018) Outcomes after open and laparoscopic appendectomy during pregnancy: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 225:40–50. https://doi.org/10.1016/j.ejogrb.2018.04.010

    Article  PubMed  Google Scholar 

  30. Sadot E, Telem DA, Arora M, Butala P, Nguyen SQ, Divino CM (2010) Laparoscopy: a safe approach to appendicitis during pregnancy. Surg Endosc 24(2):383–389. https://doi.org/10.1007/s00464-009-0571-7

    Article  PubMed  Google Scholar 

  31. Kirshtein B, Perry ZH, Avinoach E, Mizrahi S, Lantsberg L (2009) Safety of laparoscopic appendectomy during pregnancy. World J Surg 33(3):475. https://doi.org/10.1007/s00268-008-9890-4

    Article  PubMed  Google Scholar 

  32. Corneille MG, Gallup TM, Bening T et al (2010) The use of laparoscopic surgery in pregnancy: evaluation of safety and efficacy. Am J Surg 200(3):363–367. https://doi.org/10.1016/j.amjsurg.2009.09.022

    Article  PubMed  Google Scholar 

  33. Reedy MB, Galan HL, Richards WE, Preece CK, Wetter PA, Kuehl TJ (1997) Laparoscopy during pregnancy. A survey of laparoendoscopic surgeons. J Reprod Med 42(1):33–38

    CAS  PubMed  Google Scholar 

  34. Oelsner G, Stockheim D, Soriano D et al (2003) Pregnancy outcome after laparoscopy or laparotomy in pregnancy. J Am Assoc Gynecol Laparosc 10(2):200–204

    Article  Google Scholar 

  35. Pastore PA, Loomis DM, Sauret J (2006) Appendicitis in pregnancy. J Am Board Fam Med 19(6):621–626. https://doi.org/10.3122/jabfm.19.6.621

    Article  PubMed  Google Scholar 

  36. Yilmaz HG, Akgun Y, Bac B, Celik Y (2007) Acute appendicitis in pregnancy—risk factors associated with principal outcomes: a case control study. Int J Surg 5(3):192–197. https://doi.org/10.1016/j.ijsu.2006.05.005

    Article  PubMed  Google Scholar 

  37. Ibiebele I, Schnitzler M, Nippita T, Ford JB (2019) Appendicectomy during pregnancy and the risk of preterm birth: a population data linkage study. Aust N Z J Obstet Gynaecol 59(1):45–53. https://doi.org/10.1111/ajo.12807

    Article  PubMed  Google Scholar 

  38. Wei P-L, Keller JJ, Liang H-H, Lin H-C (2012) Acute appendicitis and adverse pregnancy outcomes: a nationwide population-based study. J Gastrointest Surg 16(6):1204–1211. https://doi.org/10.1007/s11605-012-1858-x

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank to Oficina de Tecnología de la información y la Comunicación of Ministerio de Salud y Protección Social from Colombia, especially to Dolly Ovalle and Luz Emilse Rincon, for providing anonymized data for this study.

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Authors and Affiliations

  1. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Unidad Camilo Torres, Bloque C4, Bogotá, Colombia

    Giancarlo Buitrago, Juan Sebastian Moyano & Hernando Gaitan

  2. Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia

    Giancarlo Buitrago, Kenndy Arevalo, Juan Sebastian Moyano & Ruben Caycedo

  3. Hospital Universitario Nacional de Colombia, Bogotá, Colombia

    Kenndy Arevalo & Ruben Caycedo

  4. Departamento de Obstetricia y Ginecología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia

    Hernando Gaitan

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  1. Giancarlo Buitrago
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Correspondence to Giancarlo Buitrago.

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Buitrago, G., Arevalo, K., Moyano, J.S. et al. Appendectomy in Third Trimester of Pregnancy and Birth Outcomes: A Propensity Score Analysis of a 6-Year Cohort Study Using Administrative Claims Data. World J Surg 44, 12–20 (2020). https://doi.org/10.1007/s00268-019-05200-x

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