Laparoscopic or open appendicectomy for suspected appendicitis in pregnancy and evaluation of foetal outcome in Australia

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. Meth...

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Bibliographic Details
Published in:ANZ journal of surgery Vol. 87; no. 5; pp. 334 - 338
Main Authors: Winter, Nicole N., Guest, Glenn D., Bozin, Michael, Thomson, Benjamin N., Mann, G. Bruce, Tan, Stephanie B. M., Clark, David A., Daruwalla, Jurstine, Muralidharan, Vijayaragavan, Najan, Neeha, Pitcher, Meron E., Vilhelm, Karina, Cox, Michael R., Lane, Steven E., Watters, David A.
Format: Journal Article
Language:English
Published: Melbourne John Wiley & Sons Australia, Ltd 01-05-2017
Subjects:
Adult
Appendectomy - adverse effects
Appendectomy - methods
Appendectomy - statistics & numerical data
appendicitis
Appendicitis - complications
Appendicitis - surgery
Australia - epidemiology
Female
Fetal Death - etiology
Gestational Age
Humans
laparoscopic appendicectomy
Laparoscopy - adverse effects
Laparoscopy - methods
Laparoscopy - statistics & numerical data
Length of Stay - statistics & numerical data
Middle Aged
Multicenter Studies as Topic
Obstetric Labor, Premature - epidemiology
Obstetric Labor, Premature - etiology
open appendicectomy
Postoperative Complications
Pregnancy
Pregnancy Complications - diagnosis
Pregnancy Complications - surgery
Pregnancy Outcome
Retrospective Studies
Risk Factors
Treatment Outcome
appendicitis
laparoscopic appendicectomy
open appendicectomy
pregnancy
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Summary: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. Method 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. Conclusion 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.
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ISSN:1445-1433
1445-2197
DOI:10.1111/ans.13750