Impact of gestational age on the management of acute appendicitis during
pregnancy: a nationwide observational study
Abstract
Objective: To compare between conservative management and
appendectomy for acute appendicitis during pregnancy by trimester.
Design: Retrospective cohort study. Setting: 632
acute-care hospitals in Japan. Population: Pregnant women
diagnosed with acute appendicitis. Methods: We conducted a
large nationwide study using a national inpatient database from July
2010 to March 2022. Comparisons were conducted using multivariable
analysis with generalized estimating equations. Main Outcome
Measures: Preterm labor, preterm delivery, or abortion, antepartum
hemorrhage, duration of hospitalization, and duration of antibiotic use.
Results: 3,158 individuals were eligible. Proportions of
conservative management versus appendectomy by trimester were 507
(49.1%) vs. 525 (50.9%) in the first, 690 (44.6%) vs. 856 (55.4%) in
the second, and 337 (58.1%) vs. 243 (41.9%) in the third. In the
second trimester, appendectomy had a higher rate of preterm delivery,
preterm labor, or abortion (OR 2.91; 95% CI 1.62–5.25). Antepartum
hemorrhage occurred more frequently for appendectomy in the first (OR
2.12; 95% CI 1.31–3.43) and third (OR 2.43; 95% CI 1.79–3.31)
trimesters. Appendectomy had longer duration of hospitalization in the
second (2.15 days; 95% CI 1.14–3.17 days) and third (3.97 days; 95%
CI 2.22–5.71 days) trimesters. Antibiotic use duration was shorter for
appendectomy in the first (−1.20 days; 95% CI −1.51 to −0.90 days) and
second (−0.61 days; 95% CI −0.90 to −0.32 days) trimesters.
Conclusions: Clinical outcomes of acute appendicitis during
pregnancy vary by trimester. Considering the appendectomy risks,
conservative management may be viable depending on the clinical context
and trimester.