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Medical/Surgical/Diseases/Complications

Poster Session 1

(96) Maternal and Pregnancy outcomes following Management of Acute Appendicitis during Pregnancy in the United States

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: To compare maternal and pregnancy outcomes according to management strategy for acute appendicitis during pregnancy.

Study Design: This retrospective cohort study was conducted using data from the 2016-2019 Nationwide Readmissions Database. Pregnant patients admitted with acute appendicitis were identified and categorized based on the initial management strategy: operative management (OM) vs. non-operative management (NOM). The primary outcomes evaluated were adverse maternal and perinatal outcomes: intrauterine fetal death (IUFD), intrauterine growth restriction (IUGR), spontaneous abortion, preterm delivery, C-section, obstetric bleeding, venous thromboembolism (VTE), chorioamnionitis. Propensity score matching was used to control for confounders including maternal age, gestational age at index admission, maternal comorbidities, maternal obstetric history, multiple gestation, and appendiceal disease severity.

Results: Among 2184 patients identified, 340 (15.6%) underwent NOM for acute appendicitis. At index admission, NOM patients were more likely to be in their first trimester, have Medicaid as primary insurance, and less likely to have a history of previous C-section (all p < 0.001). NOM patients were also less likely to have presented with complicated appendicitis. After propensity score-matched analysis, no significant differences were observed in IUFD, IUGR, spontaneous abortion, obstetric bleeding, VTE, or chorioamnionitis between the two groups. Patients who underwent OM had a higher likelihood of preterm delivery (16.0% vs. 9.0%, p = 0.007) and C-section (44.9% vs. 35.2%, p < 0.011) [Table 1]. NOM patients were more likely to have genitourinary complications during index admission, particularly pyelonephritis (7.8% vs. 0.0%, p < 0.001).

Conclusion: While operative management of appendicitis is the historical standard of care, this study suggests that there may be an increased risk of adverse maternal or perinatal outcomes with operative management.