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Objective:
To determine whether obtaining magnetic resonance imaging (MRI) in pregnant patients with suspected appendicitis minimizes length of stay (LOS) and hospital costs.
Design:
Retrospective review using univariate (t-test and Chi-square) and multivariate (linear regression) techniques.
Setting:
University tertiary referral center
Patients:
Seventy nine pregnant patients with suspected appendicitis followed through delivery over 11 years.
Interventions:
None
Main Outcome Measures:
Time to operation, hospital LOS, complications, nontherapeutic exploration, fetal outcome, and hospital cost.
Results:
Seventy nine patients (34 with appendicitis) were included. Thirty one patients underwent MRI; two undergoing CT scan and not MRI were excluded. A trend towards fewer operations; p= 0.066, OR 2.47 (0.97-6.29) was observed with MRI. There were 6 (14.0%) nontherapeutic operations in the non-MRI group and 2 in the MRI group (6.3%); p = 0.454. MRI patients were more frequently discharged from the emergency department (ED) p=0.032, OR 3.14 (1.16-8.54). Total LOS was reduced in MRI patients (33.1 hours vs. 66.1 hours; p<0.001). No patient discharged without operation returned with appendicitis. Gestational age (MRI: 17.6 weeks vs. no-MRI: 15.7 weeks; p=0.459), time to operation, (MRI: 10.5 hours vs. no-MRI: 13.6 hours; p=0.226) and perforation (MRI: 27.3% vs. no-MRI: 19.0%; p=0.667) were similar. On multivariate analysis only MRI was associated with shorter LOS (p=0.042). Average hospital costs were similar with appendicitis ($8174 MRI vs. $8544 no-MRI) and without appendicitis ($3205 MRI vs. $3615 no-MRI). One fetal loss (no MRI with appendicitis) occurred.
Conclusions:
MRI of pregnant women with suspected appendicitis does not impact clinical outcome nor hospital costs. MRI does allow safe discharge from the ED improving resource utilization.