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Appendectomy in Third Trimester of Pregnancy and Birth Outcomes: A Propensity Score Analysis of a 6-Year Cohort Study
Giancarlo Buitrago1,2, Kenndy Arevalo3,4, Juan Sebastian Moyano5,3
1Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Unidad Camilo Torres, Bloque C4, Bogotá, Colombia. gbuitragog@unal.edu.co.
Introduction:
While there is evidence of obstetric and neonatal outcomes from non-obstetric surgery during pregnancy, surgery during the third trimester of gestation has not been evaluated as a prognostic factor for those outcomes. The objective of this study was to determine whether appendectomies during the third trimester are associated with adverse neonatal outcomes, in comparison with appendectomies during the first two trimesters, based on national administrative data in Colombia.
Methods:
A retrospective cohort study was performed using administrative health records. It included all women who had live births and who underwent an appendectomy during any stage of pregnancy, between the years 2011 and 2016, and who belonged to Colombia's contributory health system. The main outcome was preterm birth. Birth weight and 1-min and 5-min Apgar scores were also measured, as well as outcomes used to identify neonatal near-miss cases. Propensity score matching was used in order to balance baseline characteristics (age, weeks of gestation, obstetric comorbidity index, and region and year the procedure was performed). Relative risks were estimated with Poisson regressions.
Results:
This study included a total of 2507 women in Colombia's contributory health system who underwent an appendectomy during pregnancy. Appendectomy was performed on 885 women (35.30%) in their first trimester, 1205 women (48.07%) in their second trimester, and 417 women (16.63%) in their third trimester. For the entire population, the preterm birth rate was 11.85 per 100 appendectomies. With the matched sample, this study found that women in their third trimester had a 1.65 greater risk of preterm birth [95% CI, 1.118-2.423], a 3.43 greater risk of birth at gestational ages < 33 weeks [95% CI, 1.363 to 8.625], 2.083 greater risk of weight under 1750 g [95% CI, 1.056-4.109], and a mean difference of - 0.247 [95% CI, - .382 to - .112] in the 1-min Apgar score and - .168a [95% CI, - .276 to - .060] in the 5-min Apgar. No differences were found in birth weight or Apgar scores < 7.
Conclusions:
In Colombia's contributory health system, women who undergo appendectomies in their third trimester have a greater risk of preterm birth, birth weight under 1750 g, birth at gestational ages less than 33 weeks, and decreased 1-min and 5-min Apgar scores.
