Is there a difference between acute appendicitis in pregnant and non-pregnant women?

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Authors: P. Guňková ^1,2; L. Tulinský ^1,2; D. Toman ^1,2; L. Martínek ^1,2; A. Vrtková ^3,4; R. Špaček ⁵; O. Šimetka ⁵
Authors‘ workplace: Chirurgická klinika FN Ostrava ¹; Katedra chirurgických studií, LF OU Ostrava ²; Katedra aplikované matematiky, FEI VŠB – Technická univerzita Ostrava ³; Útvar náměstka ředitele pro vědu, výzkum a výuku, FN Ostrava ⁴; Gynekologicko-porodnická klinika LF OU a FN Ostrava ⁵
Published in: Ceska Gynekol 2023; 88(6): 405-411
Category: Original Article
doi: https://doi.org/10.48095/cccg2023405

Overview

Objective: Acute appendicitis is the most common indication for surgical intervention during pregnancy for non-gynaecological or non-obstetric causes. The aim of this study was to compare perioperative and postoperative outcomes of acute appendectomies in pregnant and non-pregnant patients of childbearing age. Methods: A retrospective clinical study focused on the comparison of perioperative and postoperative outcomes of acute appendectomy in pregnant and non-pregnant patients of reproductive age between January 2012 and December 2021 at the University Hospital in Ostrava. Results: A number of 308 patients underwent acute appendectomy, 25 pregnant and 283 non-pregnant. There were no statistically significant differences in age, ASA (American Society of Anesthesiologists) classification, duration of complaints, baseline C-reactive protein values, sensitivity or specificity of sonography. A statistically significant difference was found in the leukocyte count between subgroups (P = 0.014) and in the number of laparoscopic procedures performed between the two subgroups (P < 0.001; 98.9% non-pregnant vs. 80.0% pregnant). There was also a statistically significant difference in the length of hospital stay, with the pregnant subgroup having a longer hospital stay (P = 0.014) and a statistically significant difference in the rate of postoperative complications between the defined subgroups (P = 0.039). Serious complications were described predominantly in the subgroup of pregnant patients, where they reached 12% compared to non-pregnant patients, where they were 2.8%. The mortality rate of the cohort was zero. Conclusion: The results of the study support the fact that pregnancy may be associated with complicated forms of acute appendicitis. Accurate and early diagnosis not only prevents the development of complicated forms of appendicitis but also reduces the number of negative appendectomies in pregnancy.

Keywords:

morbidity – acute appendicitis – appendectomy – mortality – pregnancy – laparoscopy

Sources

1. Kozan R, Bayhan H, Soykan Y et al. Acute appendicitis in pregnancy: how to manage? Sisli Etfal Hastan Tip Bul 2020; 54 (4): 457–462. doi: 10.14744/SEMB.2020.85453.

2. Frountzas M, Nikolaou C, Stergios K et al. Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies. Ann R Coll Surg Engl 2019; 101 (4): 235–248. doi: 10.1308/rcsann.2019.0011.

3. Selzer DJ, Stefanidis D. Surgical emergencies in the pregnant patient. Adv Surg 2019; 53: 161–177. doi: 10.1016/j.yasu.2019.04.008.

4. Koç C, Akbulut S, Coşkun EI et al. Comparison of the demographic and clinical features of pregnant and non-pregnant patients undergoing appendectomy. Ulus Travma Acil Cerrahi Derg 2020; 26 (4): 555–562. doi: 10.14744/tjtes. 2020.12544.

5. Franca Neto AH, Amorim MM, Nóbrega BM. Acute appendicitis in pregnancy: literature review. Rev Assoc Med Bras 2015; 61 (2): 170–177. doi: 10.1590/1806-9282.61.02.170.

6. Kalayci T, Iliklerden UH. Methods for the diagnosis of acute appenditis in pregnant women. East J Med 2019; 24 (3): 310–313. doi: 10.5505/ejm.2019.80148.

7. Pearl JP, Price RR, Tonkin AE et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 2017; 31 (10): 3767–3782. doi: 10.1007/s00464-017-5637-3.

8. Mukherjee R, Samanta S. Surgical emergencies in pregnancy in the era of modern dia g – nostics and treatment. Taiwan J Obstet Gynecol 2019; 58 (2): 177–182. doi: 10.1016/j.tjog. 2019.01.001.

9. Chakraborty J, Kong JC, Su WK et al. Safety of laparoscopic appendicectomy during pregnancy: a systematic review and meta-analysis. ANZ J Surg 2019; 89 (11): 1373–1378. doi: 10.1111/ans.14963.

10. Reproductive Health Indicators. Guidelines for their generation, interpretation and analysis for global monitoring. World Health Organization 2006. Geneva: WHO Press.

11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (2): 205–213. doi: 10.1097/01.sla.0000133083.54934.ae.

12. Ito K, Ito H, Whang EE et al. Appendectomy in pregnancy: evaluation of the risks of a negative appendectomy. Am J Surg 2012; 203 (2): 145–150. doi: 10.1016/j.amjsurg.2011.02.010.

13. Segev L, Segev Y, Rayman S et al. Acute appendicitis during pregnancy: different from the nonpregnant state? World J Surg 2017; 41 (1): 75–81. doi: 10.1007/s00268-016-3731-7.

14. Hiersch L, Yogev Y, Ashwal E et al. The impact of pregnancy on the accuracy and delay in diagnosis of acute appendicitis. J Matern Fetal Neonatal Med 2014; 27 (13): 1357–60. doi: 10.3109/14767058.2013.858321.

15. Aras A, Karaman E, Pekşen Ç et al. The dia g – nosis of acute appendicitis in pregnant versus non-pregnant women: a comparative study. Rev Assoc Med Bras 2016; 62 (7): 622–627. doi: 10.1590/1806-9282.62.07.622.

16. Garcia EM, Camacho MA, Karolyi DR et al. ACR Appropriateness Criteria^® Right lower quadrant pain-suspected appendicitis. J Am Coll Radiol 2018; 15 (11S): S373–S387. doi: 10.1016/ j.jacr.2018.09.033.

17. Seok JW, Son J, Jung KU et al. Safety of appendectomy during pregnancy in the totally laparoscopic age. J Minim Invasive Surg 2021; 24 (2): 68–75. doi: 10.7602/jmis.2021.24.2.68.

18. Adamina M, Andreou A, Arezzo A et al. EAES rapid guideline: systematic review, meta-analysis, GRADE assessment, and evidence-informed European recommendations on appendicitis in pregnancy. Surg Endosc 2022; 36 (12): 8699–8712. doi: 10.1007/s00464-022-09625-9.

19. Ashbrook M, Cheng V, Sandhu K et al. Management of complicated appendicitis during pregnancy in the US. JAMA Netw Open 2022; 5 (4): e227555. doi: 10.1001/jamanet workopen. 2022.7555.

20. Lee SH, Lee JY, Choi YY et al. Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis. BMC Surg 2019; 19 (1): 41. doi: 10.1186/s12893-019-0505-9.

21. Gök AFK, Soytaş Y, Bayraktar A et al. Laparoscopic versus open appendectomy in pregnancy: a single center experience. Ulus Travma Acil Cerrahi Derg 2018; 24 (6): 552–556. doi: 10.5505/tjtes.2018.26357.

22. Prodromidou A, Machairas N, Kostakis ID et al. Outcomes after open and laparoscopic appendectomy during pregnancy: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 225: 40–50. doi: 10.1016/j.ejogrb.2018.04. 010.

23. Austin CS, Jaronczyk M. Safe laparoscopic appendectomy in pregnant patient during active labor. J Surg Case Rep 2021; 2021 (5): rjab127. doi: 10.1093/jscr/rjab127.

24. Nakashima M, Takeuchi M, Kawakami K. Clinical outcomes of acute appendicitis during pregnancy: conservative management and appendectomy. World J Surg 2021; 45 (6): 1717–1724. doi: 10.1007/s00268-021-060 10-w.

25. Won RP, Friedlander S, Lee SL. Management and outcomes of appendectomy during pregnancy. Am Surg 2017; 83 (10): 1103–1107. doi: 10.1177/00031348170830101.

26. Ball E, Waters N, Cooper N et al. Evidence-based guideline on laparoscopy in pregnancy: commissioned by the British Society for Gynaecological Endoscopy (BSGE) endorsed by the Royal College of Obstetricians & Gynaecologists (RCOG). Facts Views Vis Obgyn 2019; 11 (1): 5–25.

27. Aggenbach L, Zeeman GG, Cantineau AE et al. Impact of appendicitis during pregnancy: no delay in accurate diagnosis and treatment. Int J Surg 2015; 15: 84–89. doi: 10.1016/ j.ijsu.2015.01.025.