Sachs Adam, Guglielminotti Jean, Miller Russell, Landau Ruth, Smiley Richard, Li Guohua
Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut2Department of Anesthesiology, University of Connecticut School of Medicine, Farmington.
Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York4Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France.
JAMA Surg. 2017 May 1;152(5):436-441. doi: 10.1001/jamasurg.2016.5045.
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.
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.
A composite measure including 7 adverse obstetrical outcomes throughout pregnancy and occurring before hospital discharge.
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).
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.
确定孕期阑尾切除术和胆囊切除术后不良产科结局的风险因素对于基于证据的风险降低和充分的患者咨询是必要的。
确定孕期阑尾切除术和胆囊切除术后不良产科结局的风险因素，并对这些结局的风险进行分层。
设计、设置和参与者：使用全国住院患者样本进行了一项队列研究，该样本是2003年1月1日至2012年12月31日期间从美国社区医院出院的具有全国代表性的患者样本。对19926名孕期接受阑尾切除术或胆囊切除术的女性进行了不良产科结局风险因素的多变量分析，并开发了此类风险因素的评分系统。数据分析于2015年1月1日至2016年7月31日进行。
一项综合指标，包括整个孕期及出院前发生的7种不良产科结局。
在该研究的19926名女性（平均[标准差]年龄，26[6]岁）中，953名孕妇（4.8%）记录了1018起不良产科事件。3种最常见的不良事件是早产（360例[35.4%]）、未发生早产的先兆早产（269例[26.4%]）和流产（262例[25.7%]）。与不良产科结局关联最密切的风险因素包括宫颈机能不全（调整比值比，24.29；95%置信区间，7.48 - 78.81）、本次孕期先兆早产（调整比值比，18.34；95%置信区间，4.95 - 67.96）、阴道炎或外阴阴道炎（调整比值比，5.17；95%置信区间，2.19 - 12.23）和败血症（调整比值比，3.39；95%置信区间，2.08 - 5.51）。基于具有统计学意义的变量的评分系统将研究样本分为3个风险组，对应不良产科结局的预测概率分别为2.5%（≤4分）、8.2%（5 - 8分）和21.8%（≥9分）。
孕期阑尾切除术或胆囊切除术后约5%的女性会出现不良产科结局。此类结局的主要风险因素是宫颈机能不全、本次孕期先兆早产、阴道炎或外阴阴道炎以及败血症。
