Surgery in pregnancy: Identifying factors contributing to variation and delay in diagnosis and management of appendicitis in pregnancy

Background: Suspected appendicitis is the most common indication for surgery for non-obstetric conditions during pregnancy. Delay in management increases the risk of appendiceal perforation and pregnancy loss. Stand-alone specialty obstetric hospitals often don’t have surgical teams on site. It has been suspected that this may be a factor that leads to delayed diagnosis and management of non-obstetric surgical conditions in pregnancy. Aims: To assess the differences in time to diagnosis, imaging, surgical management and outcomes between a stand-alone tertiary obstetric hospital and a tertiary general hospital for pregnant patients presenting with suspected appendicitis who underwent an appendicectomy. Materials and Methods: A retrospective study of all women who underwent appendicectomy in pregnancy for suspected appendicitis over a four-year period. Results: Women who attended the specialist hospital were later in gestation (medians 29 weeks vs 18 weeks, P = 0.004) and less likely to have imaging (84% vs 56%, P = 0.047) with no difference in the rates of confirmation of diagnosis of appendicitis using imaging. Women who presented to the specialist hospital were more likely to be managed with a laparotomy, admitted to high dependency unit, have a longer hospital stay and tended to be later in gestation. There was no difference in rates of positive appendicectomies, appendiceal perforation or management in under the recommended 24 h. Conclusions: The specialty obstetric hospital has a much higher rate of laparotomy and longer length of stay. The majority of patients presenting to both hospitals did not undergo surgery within 24 h and delay in imaging was a major contributor.