Trends in Acute Appendicitis Among Pregnant Women, the Risk for Cardiac Arrest and Maternal-fetal Mortality

Abstract

Abstract Introduction/Objective Acute appendicitis is the most common extra-uterine surgical emergency requiring immediate surgical intervention during pregnancy. However, risks for mortality and near-miss conditions (e.g., cardiac arrest) remain poorly understood. This study was conducted to determine the temporary changes in rate of acute appendicitis in pregnant women over time compared to their non-pregnant peers in relation to cardiac arrest, maternal mortality and stillbirth. Methods My analysis covered the period from January 1, 2002 through December 31, 2014 using cross-sectional data from the Nationwide Inpatient Sample (NIS). The NIS, made available by the Healthcare Cost and Utilization Project (HCUP), currently constitutes the largest all-payer, publicly available inpatient database in the US. Results I identified a total of 64,799 cases of acute appendicitis during pregnancy, yielding a prevalence of 11/10,000. There was a significant increase in the prevalence of appendicitis over time. While the risk for cardiac arrest was not elevated, that of maternal mortality was five times (OR = 5.16, 95% CI = 2.57-10.38) as high among mothers diagnosed with appendicitis during pregnancy. The combined risk for fetal loss or stillbirth was twice as high among individuals diagnosed with appendicitis (OR = 2.05, 95% CI = 1.85-2.28). Conclusion Appendicitis during pregnancy increases the risk for cardiac arrest, and maternal mortality by about five- fold. We also found that the risk for fetal loss or stillbirth was doubled.