Comparison of open and laparoscopic appendectomy according to the trimester of pregnancy: A nationwide observational study

Shunya Sugai; Yusuke Sasabuchi; Hideo Yasunaga; Shotaro Aso; Hiroki Matsui; Kiyohide Fushimi; Kosuke Yoshihara; Koji Nishijima

doi:10.1002/wjs.12422

Comparison of open and laparoscopic appendectomy according to the trimester of pregnancy: A nationwide observational study

World J Surg. 2024 Dec 9. doi: 10.1002/wjs.12422. Online ahead of print.

Authors

Shunya Sugai¹, Yusuke Sasabuchi², Hideo Yasunaga³, Shotaro Aso⁴, Hiroki Matsui³, Kiyohide Fushimi⁵, Kosuke Yoshihara¹, Koji Nishijima¹

Affiliations

¹ Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
² Department of Real-world Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
⁴ Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁵ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan.

PMID: 39653380
DOI: 10.1002/wjs.12422

Abstract

Objective: To compare the outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) for acute appendicitis during pregnancy by trimester.

Methods: We conducted a nationwide retrospective cohort study using the Diagnosis Procedure Combination database in Japan. We identified pregnant women diagnosed with appendicitis who underwent OA or LA from 2010 to 2022. Pathological confirmation of appendicitis was not required for inclusion. The patients were categorized by the trimester of pregnancy. Outcomes were compared using multivariate analysis with generalized estimating equations.

Results: A total of 1624 patients were included. In the first trimester, 64.2% patients underwent OA, whereas 35.8% patients underwent LA; in the second trimester, 59.1% patients had OA and 40.9% patients had LA; and in the third trimester, 72.8% patients had OA and 27.2% patients had LA. LA was associated with a higher rate of preterm labor, preterm delivery, or abortion in the second (odds ratio, 3.37; 95% confidence interval, 1.76-6.47; and p < 0.001) and third trimesters (odds ratio, 2.57; 95% confidence interval, 1.15-5.70; and p = 0.021) but not in the first trimester. The duration of surgery was longer across all trimesters in patients who underwent LA. Additionally, the postoperative hospital stay was shorter in patients who had LA than in those who had OA in the second trimester.

Conclusions: In-hospital outcomes vary by trimester, and our results suggest that LA does not consistently lead to better outcomes than OA. Based on our findings, treatment options for appendicitis during pregnancy must be carefully selected.

Keywords: abortion; acute appendicitis; appendectomy; complication; pregnancy; premature birth.

Abstract

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