Strengths and limitations
Our findings need to be interpreted in the context of some inherent
limitations of a claims database. First, this was a retrospective study.
Second, other abdominopelvic surgeries such as cholecystectomy and
myomectomy were excluded from the analysis due to their small number,
indicating the need for additional research on these procedures. Third,
there was a lack of clinical information about gestational age.
Therefore, we estimated the time interval between surgery and delivery
to control bias due to time of surgery. Fourth, because the study only
included data on patients who experienced live birth, no information
about stillbirth was available. However, it is possible that the effect
of surgery on the fetus was fully evaluated by measuring the incidence
of low birth weight and preterm birth. Finally, some important
individual data about lifestyle behaviors, such as smoking and alcohol
drinking habits, body mass index, and severity of comorbid conditions,
were not available.
Nevertheless, there were many strengths to this study and the research
approach. This is the first nationwide study to report the risk of
adverse obstetric and fetal outcomes following non-obstetric pelvic
surgery during pregnancy in Korea. This is also the largest such study
in Asia, the second largest study worldwide, and is based on a registry
database from 3.2 million pregnancies. Furthermore, it is the first
large-scale study to analyze the risk of various obstetric and fetal
complications according to laparoscopic/open surgery, type of surgery,
and time of surgery during pregnancy.