Comparison of open and laparoscopic appendectomy according to the trimester of pregnancy: A nationwide observational study

Abstract Objective To compare the outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) for acute appendicitis during pregnancy by trimester. Methods We conducted a nationwide retrospective cohort study using the Diagnosis Procedure Combination database in Japan. We identified pregnant women diagnosed with appendicitis who underwent OA or LA from 2010 to 2022. Pathological confirmation of appendicitis was not required for inclusion. The patients were categorized by the trimester of pregnancy. Outcomes were compared using multivariate analysis with generalized estimating equations. Results A total of 1624 patients were included. In the first trimester, 64.2% patients underwent OA, whereas 35.8% patients underwent LA; in the second trimester, 59.1% patients had OA and 40.9% patients had LA; and in the third trimester, 72.8% patients had OA and 27.2% patients had LA. LA was associated with a higher rate of preterm labor, preterm delivery, or abortion in the second (odds ratio, 3.37; 95% confidence interval, 1.76–6.47; and p < 0.001) and third trimesters (odds ratio, 2.57; 95% confidence interval, 1.15–5.70; and p = 0.021) but not in the first trimester. The duration of surgery was longer across all trimesters in patients who underwent LA. Additionally, the postoperative hospital stay was shorter in patients who had LA than in those who had OA in the second trimester. Conclusions In‐hospital outcomes vary by trimester, and our results suggest that LA does not consistently lead to better outcomes than OA. Based on our findings, treatment options for appendicitis during pregnancy must be carefully selected.