Cholecystectomy During the Third Trimester of Pregnancy: Proceed or Delay?

BACKGROUND: Current guidelines suggest that cholecystectomy during the third trimester of pregnancy is safe for both the woman and the fetus. However, no population-based study has examined this issue. The aim of this analysis was to compare the results of cholecystectomy during the third trimester of pregnancy with outcomes in women operated on in the early postpartum period in a large population.

METHODS: The California Office of Statewide Health Planning and Development database was queried from 2005 to 2014. Women undergoing cholecystectomy during the third trimester of pregnancy (n = 403) were compared with those having this procedure in the 3 months post partum (n = 17,490). Patient demographics as well as maternal delivery and cholecystectomy-related outcomes were compared by standard statistics as well as after adjustments for age, race, comorbidities, insurance status, and hospital setting.

RESULTS: Women who underwent cholecystectomy during the third trimester were older (27 vs 25 years; p < 0.001), but did not differ in race or insurance status. Cholecystectomy during pregnancy was more likely to require hospitalization (85% vs 63%; p < 0.001) and more likely to be performed open (13% vs 2%; p < 0.001). Composite maternal outcomes (odds ratio 1.88; p < 0.001), including preterm delivery (odds ratio 2.05; p < 0.001) as well as length of hospital stay (+0.83 days; p < 0.001) and readmissions (odds ratio 2.05; p = 0.002), were all significantly increased when cholecystectomy was performed during pregnancy.

CONCLUSIONS: Maternal delivery and procedure-related outcomes were worse when cholecystectomy was performed during the third trimester of pregnancy. Preterm delivery, which is associated with multiple adverse infant outcomes, was increased in third-trimester women. Whenever possible, cholecystectomy should be delayed until the postpartum period.