2:3 | Routines and complications
There are standard routines for antibiotic administration at South Stockholm General Hospital, and these apply to both pregnant and non-pregnant women. Routine antibiotic treatment is based on the degree of inflammation of the appendix at surgery. When no inflammation is suspected, no antibiotics are given. If the appendix is phlegmonous, one dose of 1.5 gm metronidazole iv is given, and for gangrenous appendix, 3 doses of Piperacillin Tazobactam iv are given. In cases of perforated appendix, Piperacillin Tazobactam i.v. 3 times daily is given until bowel function is restored, and thereafter Ciprofloxacin 500 mg x 2 and metronidazole 400 mg x3 by mouth.
At South Stockholm General Hospital, it is standard for pregnant women to be operated within 6 hours and non-pregnant within 24 hours after appendicitis has been diagnosed or is suspected. Thromboembolic prophylaxis is recommended for one week after surgery during pregnancy according to the Swedish algorithm for pregnant women [9].
To assess risk factors for adverse outcomes due to appendectomy within 30 days after surgery, including surgical or medical complications, readmission, and need for surgical reintervention, we reviewed data obtained from the electronic medical records, TakeCare (CompuGroup Medical, Helsinki, Finland) and Obstetrics (Cerner Sverige AB, Stockholm, Sweden) registers. Data concerning surgical procedures and background variables were transferred automatically from the Surgical Department’s planning software (Orbit 5, TietoEvry, Kristianstad, Sweden).
Initial sodium levels, CRP, white blood cell count, and ultrasound were investigated for their possible predictive value in the diagnosis of appendicitis during pregnancy.