Pregnant women with complicated appendicitis have better outcomes with immediate surgery

Pregnant women who receive immediate surgery for complicated appendicitis have better outcomes than those who receive other treatment, according to research presented at the virtual American College of Surgeons Clinical Congress.

“Currently, the management of appendicitis in the general population is somewhat controversial and is especially true for complicated appendicitis. Increasing numbers of surgeons prefer a trial of nonsurgical management; others recommend an immediate operation,” Kazuhide Matsushima, MD, FACS, an assistant professor of clinical surgery in the Keck School of Medicine at the University of Southern California, said in a press release. “This study is a great first step toward a consensus regarding the optimal management of complicated appendicitis in pregnant patients.”

Matsushima and colleagues evaluated data from the National Impatient Sample from 2003 to 2015 and identified cases of complicated appendicitis during pregnancy.

They found that 55% of patients received immediate noninvasive surgery, while 45% initially received nonoperative management, involving a course of antibiotics with or without percutaneous drainage of the appendix.

The approach of nonoperative management failed in 74% of patients, who later required an operation.

Compared with those who received immediate surgery, preterm labor, delivery and pregnancy termination were more common among women with nonoperative management, with the odds for the complications ranging from one to three times higher among those who did not receive immediate surgery.

The researchers determined that sepsis was two to four times more common among patients who did not receive immediate surgery.

Matsushima and colleagues also found that the rate of any complication was lowest among those who received an immediate operation, and that their length of stay in the hospital was overall 2 days shorter than those who did not receive immediate surgery.

“Based on the current evidence we have, which includes this study, our recommendation would be for surgeons to pursue immediate operation for pregnant patients with complicated appendicitis. Every day of delay to surgery means worse clinical outcomes for the patients as well as the fetus,” Vincent Cheng, MD, a general surgery resident and lead author of the study, said in the release.