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Is It Safe to Manage Acute Cholecystitis Nonoperatively During Pregnancy?: A Nationwide Analysis of Morbidity According to Management Strategy.
Rios-Diaz, Arturo J; Oliver, Emily A; Bevilacqua, Lisa A; Metcalfe, David; Yeo, Charles J; Berghella, Vincenzo; Palazzo, Francesco.
Afiliação
  • Rios-Diaz AJ; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
  • Oliver EA; Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania.
  • Bevilacqua LA; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
  • Metcalfe D; Oxford Trauma and Emergency Care, Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.
  • Yeo CJ; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
  • Berghella V; Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania.
  • Palazzo F; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ann Surg ; 272(3): 449-456, 2020 09 01.
Article em En | MEDLINE | ID: mdl-33759834
OBJECTIVES: To compare cholecystectomy (CCY) and nonoperative treatment (no-CCY) for acute cholecystitis in pregnancy. SUMMARY OF BACKGROUND DATA: Current Society of Gastrointestinal and Endoscopic Surgery guidelines recommend CCY over nonoperative management of acute cholecystitis during pregnancy, and the American College of Obstetricians and Gynecologists recommend medically necessary surgery regardless of trimester. This approach has been recently questioned. METHODS: Pregnant women admitted with acute cholecystitis were identified using the Nationwide Readmission Database 2010-2015. Propensity-score adjusted logistic regression models were used to compare CCY and no-CCY. The primary outcome was a composite measure of adverse maternal-fetal outcomes (intrauterine death/stillbirth, poor fetal growth, abortion, preterm delivery, C-section, obstetric bleeding, infection of the amniotic fluid, venous thromboembolism). RESULTS: There were 6390 pregnant women with acute cholecystitis: 38.2% underwent CCY, of which 5.1% were open. Patients were more likely to be managed operatively in their second trimester (First 43.9%, Second 59.1%, Third 34.2%; P < 0.01). Patients managed with CCY did not differ in age, insurance, income, Charlson Comorbidity Index, diabetes or obesity when compared to no-CCY (all P > 0.05), but were less likely to have a previous C-section, gestational diabetes, preeclampsia/eclampsia or be in the third trimester (P ≤ 0.01). Risk-adjusted analyses showed that no-CCY was associated with significantly increased maternal-fetal complications during the index admission [odds ratio 3.0 (95% confidence interval 2.08-4.34), P < 0.01] and 30-day readmissions [odds ratio 1.61 (confidence interval % CI 1.12-2.32), P < 0.01]. CONCLUSIONS: Contrary to current guidelines, most pregnant women admitted in the US with acute cholecystitis are managed nonoperatively. This is associated with over twice the odds of maternal-fetal complications in addition to increased readmissions.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações na Gravidez / Resultado da Gravidez / Colecistite Aguda / Segurança do Paciente Tipo de estudo: Guideline / Prognostic_studies Limite: Adult / Female / Humans / Pregnancy País/Região como assunto: America do norte Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações na Gravidez / Resultado da Gravidez / Colecistite Aguda / Segurança do Paciente Tipo de estudo: Guideline / Prognostic_studies Limite: Adult / Female / Humans / Pregnancy País/Região como assunto: America do norte Idioma: En Ano de publicação: 2020 Tipo de documento: Article