Appendectomy during pregnancy: rates, safety, and outcomes over a
five-year period. A hospital-based follow-up study
Abstract
Objective: To assess the outcome of pregnancy after appendectomy, the
mode of surgery used, appendectomy rates and complications. Design: A
prospective cohort study of pregnant women undergoing appendectomy.
Setting: All appendectomies at South Stockholm General Hospital,
December 2015 to February 2021. Population: Pregnant women undergoing
appendectomy. Methods: Data on preoperative imaging, surgical method,
intraoperative findings, microscopic findings, hospital stay, pregnancy,
and 30-day complications were prospectively recorded in a local
appendectomy register. Results: During the study period, 50 pregnant
women underwent appendectomy of 38 199 women giving birth. During the
same period 793 non-pregnant women underwent appendectomy and served as
controls. No differences in preterm delivery (4.5% vs. 5.6%),
small-for-gestational age (2.3% vs. 6.2%), or mode of delivery
(cesarean delivery 18.2% vs. 20.4%) were observed between pregnant
women with or without appendectomy. There were no cases of perforated
appendix in the second half of pregnancy. However, women with
gestational age > 20 weeks more frequently had an innocent
appendix compared to those operated < 20 gestational weeks
(4/11 vs. 2/39, p = 0.005). Laparoscopic surgery was used in 92% of
appendectomies < 20 weeks gestation. The appendectomy rate was
three times lower during the second half of pregnancy. Conclusion:
Appendicitis in pregnancy is not a threat as long as surgery is
conducted as soon as possible. Although a low threshold for surgery may
increase the risk of finding an innocent appendix, this is outweighed by
the lower risk for perforation and serious adverse events such as fetal
loss or preterm delivery.