Publication related to RSI or an RSI staff member
Association of treatments for acute appendicitis with pregnancy outcomes in the United States from 2000 to 2016: Results from a multi-level analysis.
BACKGROUND: Open appendectomy, laparoscopic appendectomy, and non-surgical treatment are three options to treat acute appendicitis during pregnancy. Previous studies on the association of different treatment methods for acute appendicitis with pregnancy outcomes have been limited by small sample sizes and residual confounding, especially with respect to hospital-level factors. This study aimed to investigate the association of treatment method for acute appendicitis with pregnancy outcomes using a multi-level analysis. METHODS: A retrospective cohort study was conducted based on a large electronic health records database in the United States during the period 2000 to 2016. All pregnancies diagnosed with acute appendicitis and treated in participating hospitals during the study period were included. We conducted multi-level hierarchical logistic regression to analyze both individual- and hospital-level factors for abortion, preterm labor, and cesarean section. RESULTS: A total of 10,271 acute appendicitis during pregnancy were identified during the study period. Of them, 5,872 (57.2%) were treated by laparoscopic appendectomy, 1,403 (13.7%) by open appendectomy, and 2,996 (29.2%) by non-surgical treatment. Compared with open appendectomy, both laparoscopic appendectomy (adjusted OR, 0.6, 95% CI, 0.4, 0.9) and non-surgical treatment (adjusted OR, 0.4; 95% CI, 0.3-0.7) showed a decreased risk of preterm labor. Other important individual-level determinants of adverse pregnancy outcomes included maternal age, gestational hypertension, and anemia during pregnancy, the hospital-level determinant included the number of beds. CONCLUSIONS: Compared with open appendectomy, both laparoscopic appendectomy and non-surgical treatment may be associated with a lower risk of preterm labor, without increased risks of abortion and cesarean section.
Authors
- Yang, Jianzhou, Yang J, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.; Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi, Shanxi, China.; OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
- Wen, Shi Wu, Wen SW, OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
- Krewski, Daniel, Krewski D, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.; McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.; Risk Sciences International, Ottawa, Ontario, Canada.
- Corsi, Daniel J, Corsi DJ, OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
- Walker, Mark, Walker M, OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
- Mattison, Donald, Mattison D, McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.; Risk Sciences International, Ottawa, Ontario, Canada.; Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
- Moog, Ryan, Moog R, Cerner Corporation, Kansas City, Missouri, United States of America.
- McNair, Doug, McNair D, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America.
- Huang, Huiping, Huang H, Department of Infection Control, The First Affiliated Hospital of Xia Men University, Xiamen, Fujian, China.
- Zhuang, Guihua, Zhuang G, Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
BACKGROUND: Open appendectomy, laparoscopic appendectomy, and non-surgical treatment are three options to treat acute appendicitis during pregnancy. Previous studies on the association of different treatment methods for acute appendicitis with pregnancy outcomes have been limited by small sample sizes and residual confounding, especially with respect to hospital-level factors. This study aimed to investigate the association of treatment method for acute appendicitis with pregnancy outcomes using a multi-level analysis. METHODS: A retrospective cohort study was conducted based on a large electronic health records database in the United States during the period 2000 to 2016. All pregnancies diagnosed with acute appendicitis and treated in participating hospitals during the study period were included. We conducted multi-level hierarchical logistic regression to analyze both individual- and hospital-level factors for abortion, preterm labor, and cesarean section. RESULTS: A total of 10,271 acute appendicitis during pregnancy were identified during the study period. Of them, 5,872 (57.2%) were treated by laparoscopic appendectomy, 1,403 (13.7%) by open appendectomy, and 2,996 (29.2%) by non-surgical treatment. Compared with open appendectomy, both laparoscopic appendectomy (adjusted OR, 0.6, 95% CI, 0.4, 0.9) and non-surgical treatment (adjusted OR, 0.4; 95% CI, 0.3-0.7) showed a decreased risk of preterm labor. Other important individual-level determinants of adverse pregnancy outcomes included maternal age, gestational hypertension, and anemia during pregnancy, the hospital-level determinant included the number of beds. CONCLUSIONS: Compared with open appendectomy, both laparoscopic appendectomy and non-surgical treatment may be associated with a lower risk of preterm labor, without increased risks of abortion and cesarean section.
