The use of magnetic resonance imaging in the diagnosis of suspected appendicitis in pregnancy: shortened length of stay without increase in hospital charges

Document Type

Article

Publication Title

JAMA surgery

Abstract

IMPORTANCE: Making an accurate diagnosis of appendicitis in pregnancy is critical for maternal and fetal outcomes. OBJECTIVE: To determine whether magnetic resonance (MR) imaging in pregnant patients with suspected appendicitis improves outcomes, minimizes length of stay (LOS), and lowers hospital charges. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review at a university tertiary referral center of all pregnant patients seen with abdominal pain and suspected appendicitis who were followed up through delivery during an 11-year period. MAIN OUTCOMES AND MEASURES: Time to operation, LOS, complications, nontherapeutic exploration, fetal outcomes, and hospital charges. RESULTS: Seventy-nine patients were included in this study, 34 of whom had pathology-confirmed appendicitis. Thirty-one patients underwent MR imaging. A trend toward fewer operations (odds ratio [OR], 0.45; 95% CI, 0.18-1.16; P = .07) was observed in the MR imaging group. Seven nontherapeutic explorations were performed in the non-MR imaging group and 1 nontherapeutic exploration in the MR imaging group (OR, 0.44; 95% CI, 0.08-2.32; P = .13). Patients in the MR imaging group were more frequently discharged from the emergency department (OR, 0.35; 95% CI, 0.13-0.94; P = .04) and had shorter LOS (33.7 vs 64.8 hours, P < .001). Gestational age, time to operation, and the presence of perforated appendicitis were similar between groups. No patient discharged without operation returned with appendicitis in either group. On multivariable analysis, the receipt of MR imaging (P < .001) and the absence of operative intervention (P = .001) were associated with shorter LOS. The mean hospital charges were similar in those with vs without appendicitis. One fetal loss occurred in the non-MR imaging group. CONCLUSIONS AND RELEVANCE: Magnetic resonance imaging in pregnant patients with suspected appendicitis does not affect clinical outcomes or hospital charges. It allows safe discharge from the emergency department and improves resource use.

First Page

687

Last Page

93

DOI

10.1001/jamasurg.2013.4658

Publication Date

7-1-2014

Identifier

24871698 (pubmed); 10.1001/jamasurg.2013.4658 (doi); 1875624 (pii)

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