Is It Safe To Manage Acute Cholecystitis Non-operatively During Pregnancy? A Nationwide Analysis Of Morbidity According To Management Strategy
*Arturo J Rios Diaz, *Emily A. Oliver, *Lisa A Bevilacqua, *David Metcalfe, Charles J Yeo, *Vincenzo Berghella, *Francesco Palazzo
Thomas Jefferson University Hospital, Philadelphia, PA
OBJECTIVE(S): Current guidelines favor cholecystectomy (CCY) over non-operative management of acute cholecystitis (no-CCY) during pregnancy. This approach has been recently questioned. Our study aimed to compare CCY and no-CCY for acute cholecystitis in pregnancy.
METHODS: Pregnant women admitted with acute cholecystitis were identified using the Nationwide Readmission Database 2010-2015. Patients for whom gestational age could not be estimated were excluded. Rates of stillbirth, preterm labor, cesarean section, pulmonary embolism, sepsis and hemorrhage during the admission for cholecystitis as well as 30-day readmissions in patients undergoing CCY vs. no-CCY were compared. Logistic regression controlling for patient/hospital-level confounders with propensity scores based on trimester, severity-of-illness and comorbidities was used.
RESULTS: 7,965 pregnant women were admitted with acute cholecystitis, 40.2% underwent CCY, 5% were open. Patients in the CCY group did not differ in age, insurance, income, Charlson Comorbidity Index, diabetes, obesity (all p>0.05), but were less likely to have had previous C-section (2.9% vs. 9.5%, p<0.01) or be in the third trimester (69.6% vs. 75.7%, p<0.01). Risk-adjusted analyses showed that no-CCY was associated with increased obstetric complications during the index admission (Odds Ratio 2.69 [95% Confidence Interval 2.0-3.62], p<0.01) and 30-day readmissions (1.61 [1.2-2.18], p<0.01; Table).
CONCLUSIONS: Contrary to current guidelines, most pregnant women admitted with acute cholecystitis are managed non-operatively. This is associated with over twice the odds of obstetric complications and increased readmissions.
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