Appendectomy during pregnancy: rates, safety, and outcomes over a five-year period. A hospital-based follow-up study

Figures & data

Table 1. Characteristics of pregnancy, outcome, and pregnancy complications among women with appendectomi and control group.

	Appendectomy
	n = 50
Obstetric
Extrauterin pregnancy	1
Misscarriage	1
Legal abortion	1
Abortus imminens^a	2
Tourist, delivered in home country	1
	Delivery data
	Pregnant		Pregnant
	App Group		reference group
	44		38155		p value
Maternal characteristics
0-para (n)	32	72.7%	20538	53.8%	.001
Smoker (n)	1	2.3%	868	2.4%	.9
Height (cm)	167.1	±6	166.7	±7	.6
Weight (kg)	68.2	±10	66.9	±13	.5
BMI (kg/m^2)	24.4	±4	24.1	±4	.6
In-hospital stay (d)	2.8	±1.9	2.8	±1.7	.9
Mode of delivery
Vaginal (n)	34	77.3%	28368	74.3%	.7
Vaginal instr (n)	2	4.5%	1994	5.2%	.8
Cesarean section	8	18.2%	7793	20.4%	.7
Newborn
Weight (gr)	3510	±435	3495	±559	.5
Weight deviation (%)	−0.5%	±11	−0.3%	±13	.9
Gestational age (d)	278.1	±10	277.4	±13	.7
Apgar < 7 5 min (n)	0	0.0%	976	2.6%	.3
pH umbilical cord < 7.15 (n)	5	11.4%	3735	9.8%	.7
Pregnancy complications
Preterm delivery (n)	2	4.5%	2106	5.5%	.8
Birth asphyxia (n)^b	6	13.6%	4427	11.6	.7
SGA (n)	1	2.3%	2367	6.2%	.3

Pregnant reference group = all women delivered at Sodersjukhuset without appendectomy, December 2015 to february 2021. SGA: Small-for-Gestational Age; Pregnant App group: Pregnant women with appendectomy

^aFeatus not alive at preop examination.

^bat least one of; pH umbilical cord < 7.15, apgar <7 at 5 min, or a diagnosis of asphyxia.

Table 2. Type of surgery, outcome and surgical complications of appendectomy in pregnant women compared to control group of fertile but non-pregnant women.

			Non-pregnant
	Pregnant Women		Control Group
	n = 50	%	n = 793	%	p-value
True appendicitis	44	88%	644	81.2%	.2
≤ 20 weeks (out of 39)	37	95%
>20 weeks (out of 11)^a	7	64%
Type of appendicitis
Perforated appendix	8	16%	154	19%	.6
No appendicitis	6	12%	17	2.1%	<.001
Tumor	0	0%	5	0.6%
Other	1	2%	5	0.6%
No PAD	6	12%	122	15.4%	.5
Type of Surgery
Laparoscopic surgery	39	78%	770	97.1%	<.001
Abdominal	11	22%	7	1.0%	<.001
abdominal >20 weeks^a	8	73%	na
Missing data	0		16	2%
Surgical complications (n) No	47	94%	762	96.1%	.5
Intra-abdominal absessus	1	2%	17	2.2%
Caecum	1	2%	11	1.4%
Douglas	0	0%	6	0.8%
Hematoma/ bleeding	1	2%	3	0.4%
Paralytic ileus	1	2%	7	0.9%
Wound infection	0	0%	3	0.3%
Obstetric complications
Contractions	1	2%	na
early misscarriage	1	2%	na
Asphyxia HIE2^b	1	2%	na
Half of pregnancy
First ≤ 20Weeks	39	78%	na		p < .01^c
Second > 20Weeks	11	22%	na
Trimester
1st	16	32%	na
2nd	27	54%	na
3rd	7	14%	na
Reoperation (n)	0	0%	2	0.3%
PAD	44	88%	673	84.9%	p = .15
Mortality (n)	0	0%	0	0
Thromboprophylaxis	37	74%	na

Results in number or percentages, PAD: pathological anatomical diagnosis; na: not applicable.

Control group: non-pregnant women aged 18 to 45 years with appendectomy.

^aof pregnancies > 20 weeks of gestation (n = 11), ^b of pregnancies ≤ 20 (n = 39).

^bflaccid newborn with signs of meningitis at birth.

^cSign of difference between early and late pregnancy.

Table 3. Diagnostic tests and possible diagnostic variables.

	Normal Pregnancy^d	Pregnancy with Appendectomy
		n = 50	%
Radiology
Ultrasound
Positive
Appendicitis (sensitivity)^a		33	66%
Of which positive (specificity)		33	100%
PPV (truly pos / positive test			100%
Inconclusive		16	32%
appendicitis		11
not appendicitis		5
Not performed		1	2%
Computed tomography (CT)
Positive		1	2%
Of which appendicitis		0	0%
No CT imaging		49	2%
Both CT and US		0
Laboratory tests in pregnancy
Temperature > 37.8^c		13	26%
WBC ≥ 16 (n)	3%	18	36%
CRp ≥ 20 (n)	3%	30	60%
CRP <10		6	12%
S-Sodium ≤ 136 (n = 35)	3%	22	48%	.001^b
Gangrenous (n = 4)		3	75%	.001^b
Perforated (n = 6)		6	100%

Results in number or percentages or mean and SD. WBC: white blood count; PPV: positive predictive value

^aSpecificity of positive Ultrasound = 100%, positive predictive value 100%.

Sensitivity (33/50) = 66%.

^bAs compared from expected value.

Table 4. Use of time resourses during appendectomy by pregnancy length and control group.

	1st half Pregnant		2nd half Pregnant		Non-Pregnant		Significance of
	Appendectomy		Appendectomy		Appendectomy		difference p
	n = 39	(Grp 1)	n = 11	(grp 2)	n = 793	(Grp 3)	Grp 1 vs 3	Grp 2 vs 3
	Median	Iq	Median	Iq	median	Iq
Operation type
Time from decision (hours)	4	2–6	2	2–3	6	3–11	.001	<.001
Open	na		2	2–3	3	1–6	na	.26
Laparoscopic	4	2–6	2	2–4	6	3–11	.001	.03
Operation time (min)	47	36–65	56	41–76	48	36–64	.9	.34
Open	na		55	41–76	44	42–71	na	.85
Laparoscopic	47	36–65	60	41–73	48	36–64	.83	.51
Total operation time^a (min)	114	101–134	116	106–152	108	91–130	.12	.21
Open	na		124	111–153	111	86–123	na	.16
Laparoscopic	114	101–134	102	75–132	108	91–129	.10	.63
In-Hospital stay (hours)	45	33–57	67	42–105	44	31–62	.80	.05
Open	na		78	52–105	47	20–51	na	.02
Laparoscopic	45	33–57	37	29–80	44	31—62	.76	.69

^aIncluding preparation, anestesia, operation, and postpreparation. Ig: interquartile range; na: not applicable (there were no open appendectomies <20 weeks).