Grant: Operating Grant: Data Analysis Using Existing CDN Databases and Cohorts

Emergency general surgical (EGS) conditions are very common. EGS patients present with a variety of infectious and obstructive conditions of the gastrointestinal tract which often require urgent infection control and/or the resolution of obstruction through surgical, image-guided, and/or endoscopic interventions. Non-obstetric abdominopelvic surgery for EGS conditions such as appendicitis and gallstone disease occurs in 0.2-0.5% of pregnancies - with over 358,000 deliveries in Canada per year this is equivalent to over 1,800 emergency procedures during pregnancy every year for appendicitis and gallstone disease alone. Despite how common these conditions are, significant diagnostic and management challenges during pregnancy remain. Risks of ionizing radiation from CT scans and lower diagnostic yield of abdominal sonography, as well as the presence of physiologic leukocytosis and nausea during pregnancy, can lead to delayed diagnosis. Despite the fact that emergency surgery is often necessary and supported by guidelines, patients and surgeons may be reluctant to proceed out of concern for fetal wellbeing intraoperatively, and fetal loss or preterm birth postoperatively. Our objective is to improve the care of EGS conditions during pregnancy and postpartum by filling these knowledge gaps through a population-based analysis of a broad group of EGS conditions in pregnancy and the post-partum period with a focus on maternal and peri-natal outcomes. Our work will inform opportunities for care standardization which may lead to more timely diagnosis. Understanding maternal and neonatal outcomes can support pregnant patients and their health care providers in understanding risks and benefits of undergoing a major surgery during pregnancy and inform their choices.