Association Between Trimester and Outcomes after Cholecystectomy During Pregnancy - 23/06/21

Doi : 10.1016/j.jamcollsurg.2021.03.034

Vincent Cheng, MD ^a, Kazuhide Matsushima, MD, FACS ^a,^⁎ , Matthew Ashbrook, MD ^a, Koji Matsuo, MD, PhD ^c, Morgan Schellenberg, MD, FACS ^a, Kenji Inaba, MD, FACS ^a, Kulmeet Sandhu, MD, FACS ^b
^a Division of Acute Care Surgery, University of Southern California, Los Angeles, CA
^b Division of Upper GI and General Surgery, University of Southern California, Los Angeles, CA
^c Department of Surgery, and the Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA

^∗Correspondence address: Kazuhide Matsushima, MD, FACS, Division of Acute Care Surgery, Department of Surgery, University of Southern California, 2051 Marengo St, Inpatient Tower, C5L100, Los Angeles, CA 90033.Division of Acute Care SurgeryDepartment of SurgeryUniversity of Southern California2051 Marengo St, Inpatient Tower, C5L100Los AngelesCA90033

Abstract

Background

Conventional philosophy promotes the second trimester as the ideal time during pregnancy for cholecystectomy. However, literature supporting this belief is sparse. The purpose of this study is to examine the association of trimester and clinical outcomes after cholecystectomy during pregnancy.

Study Design

The National Inpatient Sample was queried for pregnant women who underwent cholecystectomy between October 2015 and December 2017. Patients were categorized by trimester. Multivariable logistic and continuous outcome regression models were used to evaluate the association of trimester and outcomes, including maternal and fetal complications, length of stay, and hospital charges. The primary outcome was any complication—a composite of specific clinical complications, each of which were designated as secondary outcomes.

Results

A total of 819 pregnant women satisfied our inclusion criteria. Of these, 217 (26.5%) were in the first trimester, 381 (47.5%) were in the second trimester, and 221 (27.0%) were in the third trimester. Median age was 27 years (interquartile range: 23–31 years). Compared with the second trimester, cholecystectomy during the first trimester was not associated with higher rates of complications (adjusted odds ratio [AOR] 0.88, 95% confidence interval [CI]: 0.47–1.63, p = 0.68). However, cholecystectomy during the third trimester was associated with a higher rate of preterm delivery (AOR 7.20, 95% CI 3.09–16.77, p < 0.001) and overall maternal and fetal complications (AOR 2.78, 95% CI 1.71–4.53, p < 0.001). Compared with the second trimester, the third trimester was associated with 21.3% higher total hospital charges (p = 0.003).

Conclusions

Our results suggest that cholecystectomy can be performed in the first trimester without significantly increased risk of maternal and fetal complications, compared to the second trimester. In contrast, cholecystectomy during pregnancy should not be delayed until the third trimester.

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Visual Abstract

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Abbreviations and Acronyms : AOR, CCI, ICD-CM, NIS, RC, SAGES

Plan

Methods

Data source and patient eligibility

Baseline demographic and outcomes variables

	CME questions for this article available at jacscme.facs.org
	Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose. Ronald J Weigel, CME Editor, has nothing to disclose.
	Disclosures outside the scope of this work: Dr Matsuo receives honorarium payments from Chugai Pharmaceutical Co to reimburse textbook editorial expenses from Springer, and receives honorarium payments from VBL Therapeutics to reimburse investigator meeting attendance expenses. Other authors have nothing to disclose.