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Clinical Outcomes of Acute Appendicitis During Pregnancy: Conservative Management and Appendectomy

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Abstract

Purpose

We have described the epidemiology, diagnostic modality, treatment patterns, and outcomes of acute appendicitis during pregnancy.

Methods

Using a nationwide claim-based database in Japan, we analyzed the data of pregnant patients who were diagnosed with appendicitis between January 2005 and May 2019. Patient characteristics, imaging studies, length of hospital stay, proportion of fetal losses, complications, and type of antibiotics were examined.

Results

The study included 169 patients, of whom 113 patients (67%) underwent conservative management, and appendectomies were performed on 56 patients (open 25% and laparoscopic 8%). The proportion of ultrasonography, computed tomography, and magnetic resonance imaging were 97%, 17%, and 5% (for conservative management); 88%, 39%, and 13% (for appendectomy); 86%, 38%, and 21% (for open appendectomy); and 93%, 43%, and 14% (for laparoscopic appendectomy), respectively. The proportion of complicated appendicitis was 6% in conservative management and 41% in appendectomy (40% in open appendectomy and 43% in laparoscopic appendectomy), respectively.

The incidence of fetal loss was 4% in conservative management, 5% in appendectomy (2% in open appendectomy, and 14% in laparoscopic appendectomy). However, there was only one fetal loss (in laparoscopic appendectomy) in the same case of hospitalization. There were no maternal deaths or serious complications after any treatment.

Conclusion

All treatments showed acceptable outcomes in appendicitis during pregnancy. Conservative management is considered an acceptable option, especially in uncomplicated cases of appendicitis in pregnant women.

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Funding

Koji Kawakami received an advisory fee from Shin Nippon Biomedical Laboratories, Ltd., JMDC Inc., AGREE Inc.; research funds from Sumitomo Dainippon Pharma Co, Ltd., Pfizer Inc., Stella Pharma Corporation, CMIC Co., Ltd., Suntory Beverage & Food Ltd., Medical Platform Co., Ltd., and Real World Data, Co., Ltd.; and holds stocks of Real World Data, Co., Ltd. There are no patent products under development or marketed products to declare, relevant to these companies. The remaining authors have stated that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan

    Masayuki Nakashima, Masato Takeuchi & Koji Kawakami

Authors
  1. Masayuki Nakashima
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  2. Masato Takeuchi
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  3. Koji Kawakami
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Corresponding author

Correspondence to Koji Kawakami.

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Conflicts of interest

Koji Kawakami received an advisory fee from Shin Nippon Biomedical Laboratories, Ltd., JMDC Inc., AGREE Inc.; research funds from Sumitomo Dainippon Pharma Co, Ltd., Pfizer Inc., Stella Pharma Corporation, CMIC Co., Ltd., Suntory Beverage & Food Ltd., Medical Platform Co., Ltd., and Real World Data, Co., Ltd.; and holds stocks of Real World Data, Co., Ltd. There are no patent products under development or marketed products to declare relevant to these companies. Masayuki Nakashima and Masato Takeuchi declare that they have no conflicts of interest.

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Nakashima, M., Takeuchi, M. & Kawakami, K. Clinical Outcomes of Acute Appendicitis During Pregnancy: Conservative Management and Appendectomy. World J Surg 45, 1717–1724 (2021). https://doi.org/10.1007/s00268-021-06010-w

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