Original ArticleSafety of Laparoscopic Surgery for Benign Diseases during Pregnancy: A Nationwide Retrospective Cohort Study
Section snippets
Methods
In this retrospective cohort study, we used the Diagnosis Procedure Combination database, a national inpatient database for acute care inpatients in Japan, the details of which have been described elsewhere [8]. The database was established in 2003 with 82 academic hospitals; the number of participating hospitals has gradually increased since that time. As of 2016 more than 1000 hospitals, including all 82 academic hospitals and more than 90% of all tertiary emergency centers, had adopted the
Results
We identified 9065 patients who underwent abdominal surgery during pregnancy in the study period. A total of 6018 eligible patients were selected, including 4047 laparotomy patients and 1971 laparoscopy patients. Propensity score matching created 740 pairs (Fig. 1). The C-statistic of the model for calculating propensity scores was .90.
Table 1 shows the baseline patient characteristics in the unmatched and propensity score–matched groups. In the unmatched groups the laparotomy group was
Discussion
This study revealed that among 6018 pregnant patients who underwent abdominal surgery, including appendectomy, cholecystectomy, uterine myomectomy, and adnexal mass resection, there was a significant difference in the occurrence of fetal adverse events after laparoscopic surgery versus laparotomy, according to propensity score–matched analysis. Among propensity score–matched patients, the laparoscopy group had a significantly lower incidence of blood transfusion, shorter operative time, and
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2023, American Journal of Obstetrics and GynecologyCitation Excerpt :Laparoscopy has been consistently shown to be associated with shorter hospital length of stay and less postoperative pain and can be associated with less manipulation of pelvic organs and better surgical exposure. Results regarding operative time, blood loss, fetal loss, preterm birth, and birthweight are mixed, with some studies showing no difference between laparoscopy and laparotomy and others showing improved outcomes with laparoscopy.89-96 Chen et al89 reported a randomized trial of 69 pregnant patients with adnexal masses requiring surgery who were randomly assigned to either laparoscopy or laparotomy.
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Dr. Yasunaga received grants from the Ministry of Health, Labour and Welfare, Japan (H29-Policy-Designated-009 and H29-ICT-Genral-004); Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141); and the Japan Agency for Medical Research and Development (15lk1110001h0001). Dr. Fushimi received a grant from the Ministry of Health, Labour and Welfare, Japan (H29-Policy-Designated-009). The funding organizations had no role in planning research, analysis, interpretation of results, or report writing.