title: Risk Factors and Risk Stratification for Adverse Obstetrical Outcomes After Appendectomy or Cholecystectomy During Pregnancy.
abstract: Identification of risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy is necessary for evidence-based risk reduction and adequate patient counseling.
  
  
  
  To identify risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy and stratify the risk of such outcomes.
  
  
  
  A cohort study was conducted using the Nationwide Inpatient Sample, a nationally representative sample of patients discharged from community hospitals in the United States, from January 1, 2003, to December 31, 2012. Multivariable analysis of risk factors for adverse obstetric outcomes was performed for 19 926 women undergoing appendectomy or cholecystectomy during pregnancy and a scoring system for such risk factors was developed. Data analysis was conducted from January 1, 2015, to July 31, 2016.
  
  
  
  A composite measure including 7 adverse obstetrical outcomes throughout pregnancy and occurring before hospital discharge.
  
  
  
  Of the 19 926 women (mean [SD] age, 26 [6] years) in the study, 1018 adverse obstetrical events were recorded in 953 pregnant women (4.8%). The 3 most frequent adverse events were preterm delivery (360 [35.4%]), preterm labor without preterm delivery (269 [26.4%]), and miscarriage (262 [25.7%]). The risk factors associated most strongly with an adverse obstetrical outcome included cervical incompetence (adjusted odds ratio, 24.29; 95% CI, 7.48-78.81), preterm labor during current pregnancy (adjusted odds ratio, 18.34; 95% CI, 4.95-67.96), vaginitis or vulvovaginitis (adjusted odds ratio, 5.17; 95% CI, 2.19-12.23), and sepsis (adjusted odds ratio, 3.39; 95% CI, 2.08-5.51). A scoring system based on statistically significant variables classified the study sample into 3 risk groups corresponding to predicted probabilities of adverse obstetrical outcomes of 2.5% (≤4 points), 8.2% (5-8 points), and 21.8% (≥9 points).
  
  
  
  Approximately 5% of women experience adverse obstetrical outcomes after appendectomy or cholecystectomy during pregnancy. The major risk factors for such outcomes are cervical incompetence, preterm labor during current pregnancy, vaginitis or vulvovaginitis, and sepsis.
authors.affiliation: Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut2Department of Anesthesiology, University of Connecticut School of Medicine, Farmington.
authors.forename: Adam
authors.initials: A
authors.lastname: Sachs
authors.affiliation: Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York4Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Guglielminotti
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Russell
authors.initials: R
authors.lastname: Miller
authors.affiliation: Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Ruth
authors.initials: R
authors.lastname: Landau
authors.affiliation: Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Smiley
authors.affiliation: Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York6Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Guohua
authors.initials: G
authors.lastname: Li
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D001062:Appendectomy / Q000009:adverse effects*; D002763:Cholecystectomy / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology* / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D002581:Uterine Cervical Incompetence / Q000453:epidemiology; D014848:Vulvovaginitis / Q000453:epidemiology; D055815:Young Adult