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.