Management of suspected appendicitis during pregnancy—a randomized cross-sectional survey
Elin Moltubak, Roland E Andersson, Marie Blomberg, Kalle LanderholmAbstract
Introduction
Management of suspected appendicitis during pregnancy is challenging. This study examined whether pregnancy influences surgeons’ management and whether surgeon characteristics affect these decisions.
Methods
A randomized, single-blind, population-based cross-sectional survey was conducted among Swedish surgeons on emergency call (March–April 2025). Surgeons were randomized 1:1 between two questionnaires describing identical clinical cases of suspected appendicitis (low, intermediate, high probability by AIR-score) differing only by pregnancy status. Primary outcomes were management decisions and adherence to AIR-score recommendations. Secondary outcomes included associations with surgeon characteristics and personality traits (validated Tolerance For Ambiguity (TFA) and Physician Risk Attitude (PRA) scales).
Results
Of 892 eligible surgeons, 370 (41.5%) responded. Pregnancy influenced management decisions. In the low-probability case, admission was more often chosen for pregnant patients (8.9% versus 3.2%, OR 2.99, 95% c.i. 1.14–7.82). In the intermediate-probability case, observation was preferred for pregnant patients (65.0% versus 36.8%, OR 3.18, 95% c.i. 2.08–4.87), while surgery was more common in non-pregnant patients (22.2% versus 41.1%, OR 0.38, 95% c.i. 0.24–0.61). Adherence to AIR-score recommendations was higher in pregnancy in the intermediate case (73.9% versus 47.3%, OR 3.14, 95% c.i. 2.03–4.87). Surgeons were less likely to use clinical scoring systems but more likely to request imaging for pregnant patients. Greater experience was associated with less risk-averse preferences. TFA and PRA scores were not associated with management decisions.
Discussion
Pregnancy leads to more cautious management of suspected appendicitis and less usage of clinical scores. Decision-making appears driven by pregnancy status and diagnostic uncertainty rather than surgeons’ personality traits.