Pregnant Women Have Same Low Rate Of Adverse Surgical Outcomes As Non-Pregnant Patients

Robert A. Meguid, MD MPH FACS Assistant Professor Section of General Thoracic Surgery Division of Cardiothoracic Surgery Department of Surgery University of Colorado Denver | Anschutz Medical Campus Aurora, CO 80045MedicalResearch.com Interview with:
Robert A. Meguid, MD MPH FACS

Assistant Professor Section of General Thoracic Surgery
Division of Cardiothoracic Surgery Department of Surgery
University of Colorado Denver | Anschutz Medical Campus
Aurora, CO 80045

Medical Research: What is the background for this study? What are the main findings?

Dr. Meguid: The surgical literature on adverse outcomes after surgery on pregnant patients is conflicting.  We know that the majority of surgery performed on pregnant patients is not elective (and just over 50% of it in the database studied was emergency surgery).  We expected to find an increased rate of adverse outcomes in those pregnant patients.  However, when we matched the pregnant and non-pregnant women who underwent surgery in the database, with excellent matching on all available preoperative characteristics and on the actual operation performed, we found similar, low rates of 30-day postoperative death and complication.  In this study, pregnant patients had undergone a broad spectrum of different types of operations, including general, vascular, thoracic, head and neck, non-obstetric gynecologic and urologic, orthopedic, reconstructive, and neuro-surgery.  Given the concern that we as surgeons have over operating on pregnant patients, both for the well-being of the patient and her child, our findings are reassuring.  This suggests that we as a medical profession are diligent in minimizing risk to pregnant women who need surgery that cannot be delayed until after the child’s birth.  Again, this study faces the limitations of being unable to assess any short term harm done to the fetus and the subsequent long term outcome of the child.

Medical Research: What should clinicians and patients take away from your report?

Dr. Meguid: The message of the findings of this study to clinicians and patients is that pregnant women who must undergo surgery have a similarly low risk of adverse outcomes (death and other complications) as comparable non-pregnant women.  As we are not able to assess the impact on the fetus using the database studied, we still advocate that elective surgery which can safely be postponed until after pregnancy be done so

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Meguid: The inclusion of specific outcomes for populations of interest (in this case, fetal outcomes in observational databases including pregnant women) is valuable for further refinement of questions such as the one we asked. In this era of the electronic health record, we still record data and report outcomes by hand. We hope that in the near future, the electronic health record can become a reliable source of clinical data for comparable studies, opening up the door to engage in near-real time, high volume data analysis to further shape our clinical decisions.

Citation:

Moore HB, Juarez-Colunga E, Bronsert M, et al. Effect of Pregnancy on Adverse Outcomes After General Surgery. JAMA Surg. Published online May 13, 2015. doi:10.1001/jamasurg.2015.91.

 

MedicalResearch.com Interview with: Robert A. Meguid, MD MPH FACS (2015). Pregnant Women Have Same Low Rate Of Adverse Surgical Outcomes As Non-Pregnant Patients