Evaluation of management and surgical outcomes in pregnancies complicated by acute cholecystitis

El-Messidi, Amira
Alsarraj, Ghazi
Czuzoj-Shulman, Nicholas
Mishkin, Daniel S.
Abenhaim, Haim Arie

¹Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, Canada
²Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada
³Center for Clinical Epidemiology, Jewish General Hospital, Montreal, Canada
⁴Division of Gastroenterology, Atrius Health, Harvard Medical School, Boston, USA

Corresponding author: Haim A. Abenhaim, MD, MPH, FRCSC, Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pavilion H, Rooms 325, 5790 Cote-des-Neiges Road, Montreal, Quebec, H3S 1Y9, Montreal, Canada, Tel.: 514-340-8222 x25488, Fax: 514-340-7491

Received March 17, 2017; Accepted November 07, 2017; previously published online January 25, 2018

e-mail: [email protected]

Journal of Perinatal Medicine 46(9):p 998-1003, December 1, 2018. | DOI: 10.1515/jpm-2017-0085

Abstract

Objective:

To evaluate the management of pregnancies complicated by acute cholecystitis (AC) and determine whether pregnant women are more likely to have medical and surgical complications.

Methods:

We carried out a population-based matched cohort study using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. Pregnant women with AC were age matched to non-pregnant women with AC on a 1:5 ratio. Management and outcomes were compared using descriptive analysis and conditional logistic regression.

Results:

There were 11,835 pregnant women admitted with AC who were age matched to 59,175 non-pregnant women. As compared to non-pregnant women, women with AC were more commonly managed conservatively, odds ratio (OR) 6.1 (5.8-6.4). As compared to non-pregnant women, pregnant women with AC more commonly developed sepsis [OR 1.4 (1.0-1.9)], developed venous thromboembolism [OR 8.7 (4.3-17.8)] and had bowel obstruction [OR 1.3 (1.1-1.6)]. Among pregnant women with AC, surgical management was associated with a small but significant increased risk of septic shock and bile leak.

Conclusion:

AC, in the context of pregnancy, is associated with an increased risk of adverse outcomes. Although the literature favors early surgical intervention, pregnancies with AC appear to be more commonly managed conservatively with overall comparable outcomes to surgically managed AC. Conservative management may have a role in select pregnant women with AC.