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Surgical trends in the management of acute cholecystitis during pregnancy

Surgical Endoscopy volume 35, pages 5752–5759 (2021)Cite this article

Abstract

Background

Since 2007, clinical practice guidelines by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommend early surgical management with laparoscopic cholecystectomy for pregnant women with symptomatic gallbladder disease regardless of trimester. However, little is known about practice patterns in the management of pregnant patients with acute cholecystitis. This study aims to examine nationwide trends in the surgical management of acute cholecystitis, as well as their impact on clinical outcomes during pregnancy.

Methods

The National Inpatient Sample was queried for all pregnant women diagnosed with acute cholecystitis between January 2003 and September 2015. After applying appropriate weights, multivariate regression analysis adjusted for patient- and hospital-level characteristics and quantified the impact of discharge year (2003–2007 versus 2008–2015) on cholecystectomy rates and timing of surgery. Multivariate regression analysis was also used to examine the impact of same admission cholecystectomy and its timing on maternal and fetal outcomes.

Results

A total of 23,939 pregnant women with acute cholecystitis satisfied our inclusion criteria. The median age was 26 years (interquartile range: 22–30). During the study period, 36.3% were managed non-operatively while 59.6% and 4.1% underwent laparoscopic and open cholecystectomy, respectively. After adjusting for covariates, laparoscopic cholecystectomy was more commonly performed after 2007 (odds ratio [OR] 1.333, p < 0.001). Furthermore, time from admission to surgery was significantly shorter in the latter study period (regression coefficient -0.013, p < 0.001). Compared to non-operative management, laparoscopic cholecystectomy for acute cholecystitis was significantly associated with lower rates of preterm delivery, labor, or abortion (OR 0.410, p < 0.001). Each day that laparoscopic cholecystectomy was delayed significantly associated with an increased risk of fetal complications (OR 1.173, p < 0.001).

Conclusions

This nationwide study exhibits significant trends favoring surgical management of acute cholecystitis during pregnancy. Although further studies are still warranted, early laparoscopic cholecystectomy should be considered in pregnant patients with acute cholecystitis.

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Acknowledgements

This study does not have any additional acknowledgements.

Funding

No funding was accepted to conduct this study.

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Affiliations

  1. Division of Acute Care Surgery, Department of Surgery, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA

    Vincent Cheng, Kazuhide Matsushima, Matthew Ashbrook, Kenji Inaba & Demetrios Demetriades

  2. Division of Upper GI and General Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA

    Kulmeet Sandhu

  3. Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA

    Koji Matsuo

Authors
  1. Vincent Cheng
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  2. Kazuhide Matsushima
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  3. Kulmeet Sandhu
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  4. Matthew Ashbrook
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  5. Koji Matsuo
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Correspondence to Kazuhide Matsushima.

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Disclosures

Koji Matsuo receives an honorarium from Chugai, is paid for textbook editorial expenses from Springer, and investigator meeting attendance expenses from VBL therapeutics. Vincent Cheng declares no conflict of interest. Kazuhide Matsushima, Kulmeet Sandhu, Matthew Ashbrook, Kenji Inaba and Demetrios Demetriades declare no conflict of interest.

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Cheng, V., Matsushima, K., Sandhu, K. et al. Surgical trends in the management of acute cholecystitis during pregnancy. Surg Endosc 35, 5752–5759 (2021). https://doi.org/10.1007/s00464-020-08054-w

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  • DOI: https://doi.org/10.1007/s00464-020-08054-w

Keywords

  • Pregnancy
  • Acute cholecystitis
  • Management
  • Cholecystectomy
  • Trends
  • Outcomes