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Original Investigation
January 18, 2017

Risk Factors and Risk Stratification for Adverse Obstetrical Outcomes After Appendectomy or Cholecystectomy During Pregnancy

Author Affiliations
  • 1Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut
  • 2Department of Anesthesiology, University of Connecticut School of Medicine, Farmington
  • 3Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
  • 4Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France
  • 5Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York
  • 6Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
JAMA Surg. Published online January 18, 2017. doi:10.1001/jamasurg.2016.5045
Key Points

Question  What are the risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy?

Findings  In this cohort study of 19 926 women undergoing these procedures in the United States, the risk factors most associated with an adverse obstetrical outcome were cervical incompetence, preterm labor during the current pregnancy, vaginitis or vulvovaginitis, and sepsis.

Meaning  Obstetrical risk factors, instead of risk factors associated with maternal characteristics, disease severity, or surgical technique, are most associated with negative pregnancy outcomes after appendectomy and cholecystectomy.

Abstract

Importance  Identification of risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy is necessary for evidence-based risk reduction and adequate patient counseling.

Objectives  To identify risk factors for adverse obstetrical outcomes after appendectomy and cholecystectomy during pregnancy and stratify the risk of such outcomes.

Design, Setting, and Participants  A cohort study was conducted using the Nationwide Inpatient Sample, a nationally representative sample of patients discharged from community hospitals in the United States, from January 1, 2003, to December 31, 2012. Multivariable analysis of risk factors for adverse obstetric outcomes was performed for 19 926 women undergoing appendectomy or cholecystectomy during pregnancy and a scoring system for such risk factors was developed. Data analysis was conducted from January 1, 2015, to July 31, 2016.

Main Outcomes and Measures  A composite measure including 7 adverse obstetrical outcomes throughout pregnancy and occurring before hospital discharge.

Results  Of the 19 926 women (mean [SD] age, 26 [6] years) in the study, 1018 adverse obstetrical events were recorded in 953 pregnant women (4.8%). The 3 most frequent adverse events were preterm delivery (360 [35.4%]), preterm labor without preterm delivery (269 [26.4%]), and miscarriage (262 [25.7%]). The risk factors associated most strongly with an adverse obstetrical outcome included cervical incompetence (adjusted odds ratio, 24.29; 95% CI, 7.48-78.81), preterm labor during current pregnancy (adjusted odds ratio, 18.34; 95% CI, 4.95-67.96), vaginitis or vulvovaginitis (adjusted odds ratio, 5.17; 95% CI, 2.19-12.23), and sepsis (adjusted odds ratio, 3.39; 95% CI, 2.08-5.51). A scoring system based on statistically significant variables classified the study sample into 3 risk groups corresponding to predicted probabilities of adverse obstetrical outcomes of 2.5% (≤4 points), 8.2% (5-8 points), and 21.8% (≥9 points).

Conclusions and Relevance  Approximately 5% of women experience adverse obstetrical outcomes after appendectomy or cholecystectomy during pregnancy. The major risk factors for such outcomes are cervical incompetence, preterm labor during current pregnancy, vaginitis or vulvovaginitis, and sepsis.

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