A. Azim1, P. Rhee1, T. Orouji Jokar1, N. Kulvatunyou1, T. O’Keeffe1, A. Tang1, R. Latifi1, G. Vercruysse1, D. Green1, R. Friese1, B. Joseph1 1University Of Arizona,Trauma Surgery,Tucson, AZ, USA
Introduction:
Laparoscopic surgical technique is a standard of care for common surgical procedure such as appendectomy and cholecystectomy. Pregnant patients are a high-risk group for these surgeries and provide several technical difficulties. The aim of this study was to determine outcomes between open vs. laparoscopic surgical approaches in pregnant patients with acute cholecysitis and acute appendicitis. We hypothesized that laparoscopic procedure is a safe approach in pregnant patients with acute abdomen.
Methods:
We performed a four-year (2008-2011) retrospective analysis of national inpatient sample database. All pregnant patients who underwent operative procedure for the diagnosis of acute appendicitis and acute cholecystitis were included in the analysis. Patients with laparoscopic and open procedures were matched for age, type of admission, day of admission, location and teaching status of the hospital, severity of illness, and indication for procedure by using propensity score matching in 1:1 ratio. Matched samples were compared using t-test (parametric), chi-square, and Kruskall-Wallis (non-parametric) tests.
Results:
A total of 252 pregnant patients with the diagnosis of acute abdomen were identified. 213 required operative intervention. After propensity score matching 128 (64 laparoscopic: 64 open) were included in the analysis. Mean age of the population was 27 ± 6, 54% underwent appendectomy, and 46% underwent cholecystectomy. There was no difference in age (p=0.7), type of operation (p=0.3), day of admission (p=0.3), location (p=0.5) and teaching status of the hospital (p=0.8), severity of illness (p=0.7), and indication for procedure (p=0.9). Hospital length of stay (2.1± 1.9 vs. 3 ± 2, p=0.005) and total charges (22612 [12495-27786] vs. 29552 [16712- 34222], p=0.017) were significantly lower in laparoscopic group. There was no difference in complications (p=0.9). No fetal loss was seen in both groups. Table1 shows the comparison of the outcomes among the two groups.
Conclusion:
Minimally invasive approach to acute appendicitis and cholecystitis in pregnant patients is safe and cost effective. Avoidance of minimally invasive approach in pregnancy for fear of fetal complications is unwarranted.
