Management of Appendicitis During Pregnancy

Abstract

IntroductionNonoperative management of appendicitis is increasingly common, however its role in pregnancy is unclear. Appendectomy and appendicitis treated with antibiotics can both increase the risk of adverse pregnancy outcomes (APO). We aim to characterize trends in the use of nonoperative management and the incidence of APO with either treatment. Methods A retrospective cohort study of patients with appendicitis during singleton pregnancies (14-55y) using the IBM MarketScan Research Databases (2007-2019), applying a unique algorithm to determine gestational age from administrative claims. Appendicitis, appendectomy within 2 days of diagnosis, and APO (pregnancy loss and preterm birth) were defined using claims, and multivariable logistic regression was used to account for differences in patient characteristics and disease severity. Results 3,735 patients were diagnosed with appendicitis during pregnancy, of whom 7.1% were initially managed without surgery. This proportion increased significantly over the study period, from 4.5% in 2007 to 12% in 2019 (p<0.001). APO were similar between those managed with and without surgery in the first and third trimesters, however nonoperative management in the second trimester was associated with a significantly higher incidence of APO (28% vs. 18%, p = 0.014). This association remained statistically significant after adjusting for pregnancy risk factors and appendicitis severity (adjusted odds ratio 1.75, 95% Ci 1.09-2.81). Conclusions Nonoperative management is increasingly used for appendicitis in pregnancy. While this strategy appears to have similar outcomes to surgery for first and third trimester cases, nonoperative management in the second trimester may be associated with greater risk of APO.