Papers

Fertility patterns after appendicectomy: historical cohort study

Roland Andersson, senior registrar, ^a Mats Lambe, lecturer, ^b Reinhold Bergström, professor. ^c

^a Division of Surgery, University Hospital, Linköping, Sweden, ^b Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden, ^c Department of Statistics, Uppsala University, Uppsala, Sweden

Correspondence to: Dr Andersson, Department of Surgery, Ryhov Hospital, S-551 85 Jönköping, Sweden roland.andersson{at}ryhov.ltjkpg.se

Objective: To examine fertility patterns in women who had their appendix removed in childhood.
Design: Historical cohort study with computerised data and fertility data for this cohort and for an age matched cohort of women from the Swedish general population. The cohorts were followed to 1994.
Setting: General population.
Participants: 9840 women who were under 15 years when they underwent appendicectomy between 1964 and 1983; 47 590 control women.
Main outcome measures: Diagnoses at discharge. Distributions of age at birth of first child among women with perforated and non-perforated appendix and women who underwent appendicectomy but were found to have a normal appendix compared with control women by using survival analysis methods. Parity distributions at the latest update of the registry were also examined.
Results: Women with a history of perforated appendix had a similar rate of first birth as the control women (adjusted hazard ratio 0.95; 95% confidence interval 0.88 to 1.04) and had a similar distribution of parity at the end of follow up. Women who had had a normal appendix removed had an increased rate of first births (1.48; 1.42 to 1.54) and on average had their first child at an earlier age and reached a higher parity than control women.
Conclusion: A history of perforated appendix in childhood does not seem to have long term negative consequences on female fertility. This may have important implications for the management of young women with suspected appendicitis as the liberal attitude to surgical explorations with a subsequently high rate of removal of a normal appendix is often justified by a perceived increased risk of infertility after perforation. Women whose appendix was found to be normal at appendicectomy in childhood seem to belong to a subgroup with a higher fertility than the general population.