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.
PLoS One. 2021 Dec 13;16(12):e0260991. doi: 10.1371/journal.pone.0260991. eCollection 2021.
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.
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.
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.
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.
在治疗妊娠期急性阑尾炎时，有开腹阑尾切除术、腹腔镜阑尾切除术和非手术治疗三种选择。既往关于不同治疗方法与妊娠结局之间关系的研究受到样本量小和残留混杂因素的限制，特别是在医院层面的因素。本研究旨在通过多水平分析研究急性阑尾炎治疗方法与妊娠结局的关系。
这是一项在美国一个大型电子健康记录数据库中进行的回顾性队列研究，研究时间为 2000 年至 2016 年。纳入研究期间在参与医院诊断为急性阑尾炎并接受治疗的所有妊娠病例。我们采用多水平分层逻辑回归分析个体和医院层面的因素与流产、早产和剖宫产的关系。
在研究期间共确定了 10271 例妊娠期急性阑尾炎。其中，5872 例（57.2%）采用腹腔镜阑尾切除术治疗，1403 例（13.7%）采用开腹阑尾切除术治疗，2996 例（29.2%）采用非手术治疗。与开腹阑尾切除术相比，腹腔镜阑尾切除术（校正比值比，0.6；95%置信区间，0.40.9）和非手术治疗（校正比值比，0.4；95%置信区间，0.30.7）均显示早产风险降低。不良妊娠结局的其他重要个体层面决定因素包括产妇年龄、妊娠期高血压和贫血，医院层面的决定因素包括床位数量。
与开腹阑尾切除术相比，腹腔镜阑尾切除术和非手术治疗可能与早产风险降低相关，而流产和剖宫产风险无增加。
