title: Laparoscopic appendectomy and cholecystectomy versus open: a study in 1999 pregnant patients.
abstract: BACKGROUND
  When pregnant patients require surgery, whether to perform an operation open or laparoscopic is often debated. We evaluated the impact of laparoscopy for common general surgical problems in pregnancy to determine safety and trends in operative approach over time.
  
  
  METHODS
  Pregnant patients undergoing appendectomy or cholecystectomy were identified using the National Surgical Quality Improvement Program (NSQIP) database. We analyzed demographics, operative characteristics, and outcomes. Univariate comparison and multivariate regression analysis (MVA) were performed adjusting for confounding factors: age, body mass index (BMI), diabetes, and smoking, and an additional MVA was performed for perforated cases.
  
  
  RESULTS
  A total of 1999 pregnant patients between 2005 and 2012 were evaluated. Of 1335 appendectomies, 894 were performed laparoscopically (LA) and 441 open (OA). For 664 cholecystectomies, 606 were laparoscopic (LC) and 58 open (OC). There were no deaths. For LA versus OA, patient characteristics were not different {age: 27.7 vs. 28.2 years, p = 0.19; diabetes: 1.8 vs. 0.9%, p = 0.24; smoking: 19 vs. 16.1%, p = 0.2} except for BMI (27.9 vs. 28.4 kg/m(2); p = 0.03). LA had shorter operative times (ORT), length of stay (LOS), and fewer postoperative complications compared to OA. In MVA, difference between approaches remained statistically significant for ORT (<0.0001), LOS (<0.01), and wound complications (<0.01). MVA was performed for perforated cases alone: LA had equal ORT (p = 0.19) yet shorter LOS (p = <0.001). The majority of LA were performed in the last 4 years versus the first 4 years (61 vs. 39%, p < 0.001). For LC versus OC, patient characteristics were not different: age (28.3 vs. 28.7 years; p = 0.33), BMI (31.4 vs. 33.2 kg/m(2), p = 0.25), diabetes (2.8 vs. 3.5%, p = 0.68), and smoking (21.1 vs. 25.9%, p = 0.4). LC had a shorter ORT, LOS, and fewer postoperative complications than OC. In MVA, the difference between approaches remained statistically significant for ORT (<0.0001), LOS (<0.0001), and minor complications (<0.01). In MVA for cholecystitis with perforation, no difference was seen for LOS, ORT, or postoperative complications (p > 0.05). The percentage of LC cases appeared to increase over time (89 vs. 93%, p = 0.06).
  
  
  CONCLUSIONS
  While fetal events are unknown, LA and LC in pregnant patients demonstrated shorter ORT, LOS, and reduced complications and were performed more frequently over time. Even in perforated cases, laparoscopy appears safe in pregnant patients.
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA. tiffany.c.cox@carolinas.org.
authors.forename: T C
authors.initials: TC
authors.lastname: Cox
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Huntington
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Blair
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
authors.forename: T
authors.initials: T
authors.lastname: Prasad
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Lincourt
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
authors.forename: V A
authors.initials: VA
authors.lastname: Augenstein
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA. todd.heniford@carolinashealthcare.org.
authors.forename: B T
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D015992:Body Mass Index; D002763:Cholecystectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D058996:Quality Improvement; D012189:Retrospective Studies; D012449:Safety; D013530:Surgical Wound Infection / Q000453:epidemiology; D055815:Young Adult
keywords: Appendectomy; Cholecystectomy; Laparoscopy; NSQIP; Outcomes; Pregnancy