Laparoscopic or open appendicectomy for suspected appendicitis in pregnancy and evaluation of foetal outcome in Australia.
BACKGROUND
Recent data suggest that laparoscopic appendicectomy (LA) in pregnancy is associated with higher rates of foetal loss when compared to open appendicectomy (OA). However, the influence of gestational age and maternal age, both recognized risk factors for foetal loss, was not assessed.


METHODS
This was a multicentre retrospective review of all pregnant patients who underwent appendicectomy for suspected appendicitis from 2000 to 2012 across seven hospitals in Australia. Perioperative data and foetal outcome were evaluated.


RESULTS
Data on 218 patients from the seven hospitals were included in the analysis. A total of 125 underwent LA and 93 OA. There were seven (5.6%) foetal losses in the LA group, six of which occurred in the first trimester, and none in the OA group. After matching using propensity scores, the estimated risk difference was 5.1% (95% confidence interval (CI): 1.4%, 9.8%). First trimester patients were more likely to undergo LA (84%), while those in the third were more likely to undergo OA (85%). Preterm delivery rates (6.8% LA versus 8.6% OA; CI: -12.6%, 5.3%) and hospital length of stay (3.7 days LA versus 4.5 days OA; CI: -1.3, 0.2 days) were similar.


CONCLUSIONS
This is the largest published dataset investigating the outcome after LA versus OA while adjusting for gestational and maternal age. OA appears to be a safer approach for pregnant patients with suspected appendicitis.
Department of Surgery, Barwon Health, Geelong, Victoria, Australia.|Department of Specialist General Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Nicole N
NN
Winter
Department of Surgery, Barwon Health, Geelong, Victoria, Australia.
Glenn D
GD
Guest
Department of Specialist General Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Michael
M
Bozin
Department of Specialist General Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Benjamin N
BN
Thomson
Breast Service, The Royal Women's Hospital, The University of Melbourne, Parkville, Victoria, Australia.
G Bruce
GB
Mann
Department of Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Stephanie B M
SBM
Tan
Department of Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
David A
DA
Clark
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.
Jurstine
J
Daruwalla
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.
Vijayaragavan
V
Muralidharan
Department of Surgery, Western Health, Footscray, Victoria, Australia.
Neeha
N
Najan
Department of Surgery, Western Health, Footscray, Victoria, Australia.
Meron E
ME
Pitcher
Department of Surgery, Nepean Hospital, Kingswood, New South Wales, Australia.
Karina
K
Vilhelm
Department of Surgery, University of Sydney Clinical School, Nepean Hospital, Kingswood, New South Wales, Australia.
Michael R
MR
Cox
Biostatistics Unit, Barwon Health, Geelong, Victoria, Australia.|School of Medicine, Deakin University, Geelong, Victoria, Australia.
Steven E
SE
Lane
Department of Surgery, Barwon Health, Deakin University, Geelong, Victoria, Australia.
David A
DA
Watters
D000328:Adult; D001062:Appendectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D001315:Australia / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
appendicitis; laparoscopic appendicectomy; open appendicectomy; pregnancy