Surgical trends in the management of acute cholecystitis during pregnancy

Vincent Cheng; Kazuhide Matsushima; Kulmeet Sandhu; Matthew Ashbrook; Koji Matsuo; Kenji Inaba; Demetrios Demetriades

doi:10.1007/s00464-020-08054-w

Surgical trends in the management of acute cholecystitis during pregnancy

Surg Endosc. 2021 Oct;35(10):5752-5759. doi: 10.1007/s00464-020-08054-w. Epub 2020 Oct 6.

Authors

Vincent Cheng¹, Kazuhide Matsushima², Kulmeet Sandhu³, Matthew Ashbrook¹, Koji Matsuo⁴, Kenji Inaba¹, Demetrios Demetriades¹

Affiliations

¹ Division of Acute Care Surgery, Department of Surgery, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA.
² Division of Acute Care Surgery, Department of Surgery, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA. kazuhide.matsushima@med.usc.edu.
³ Division of Upper GI and General Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA.
⁴ Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.

PMID: 33025256
DOI: 10.1007/s00464-020-08054-w

Abstract

Background: Since 2007, clinical practice guidelines by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommend early surgical management with laparoscopic cholecystectomy for pregnant women with symptomatic gallbladder disease regardless of trimester. However, little is known about practice patterns in the management of pregnant patients with acute cholecystitis. This study aims to examine nationwide trends in the surgical management of acute cholecystitis, as well as their impact on clinical outcomes during pregnancy.

Methods: The National Inpatient Sample was queried for all pregnant women diagnosed with acute cholecystitis between January 2003 and September 2015. After applying appropriate weights, multivariate regression analysis adjusted for patient- and hospital-level characteristics and quantified the impact of discharge year (2003-2007 versus 2008-2015) on cholecystectomy rates and timing of surgery. Multivariate regression analysis was also used to examine the impact of same admission cholecystectomy and its timing on maternal and fetal outcomes.

Results: A total of 23,939 pregnant women with acute cholecystitis satisfied our inclusion criteria. The median age was 26 years (interquartile range: 22-30). During the study period, 36.3% were managed non-operatively while 59.6% and 4.1% underwent laparoscopic and open cholecystectomy, respectively. After adjusting for covariates, laparoscopic cholecystectomy was more commonly performed after 2007 (odds ratio [OR] 1.333, p < 0.001). Furthermore, time from admission to surgery was significantly shorter in the latter study period (regression coefficient -0.013, p < 0.001). Compared to non-operative management, laparoscopic cholecystectomy for acute cholecystitis was significantly associated with lower rates of preterm delivery, labor, or abortion (OR 0.410, p < 0.001). Each day that laparoscopic cholecystectomy was delayed significantly associated with an increased risk of fetal complications (OR 1.173, p < 0.001).

Conclusions: This nationwide study exhibits significant trends favoring surgical management of acute cholecystitis during pregnancy. Although further studies are still warranted, early laparoscopic cholecystectomy should be considered in pregnant patients with acute cholecystitis.

Keywords: Acute cholecystitis; Cholecystectomy; Management; Outcomes; Pregnancy; Trends.

MeSH terms

Adult
Cholecystectomy
Cholecystectomy, Laparoscopic*
Cholecystitis, Acute* / surgery
Female
Gallbladder Diseases*
Humans
Infant, Newborn
Length of Stay
Pregnancy