| Description |
- Objective:
Cesarean hysterectomy for placenta accreta spectrum (PAS) is associated with increased risk of post-partum hemorrhage and severe maternal morbidity (SMM). The current literature lacks large multicenter studies of cesarean hysterectomy for PAS in the US. The aim of our study is
to evaluate the incidence of severe maternal morbidity (SMM) events and intensive care unit (ICU) admissions in patients who undergo cesarean hysterectomy for placenta accreta spectrum (PAS).
Methods:
We conducted a retrospective study to identify patients with a diagnosis of PAS who had cesarean hysterectomy using delivery hospitalizations in the Premier Inc. Database (10/1/2015- 6/30/2021). We collected information about patient demographics, hospital characteristics, intraoperative details, post-operative outcomes, and SMM events excluding hysterectomy using ICD-10 diagnosis codes. Descriptive statistics were used to describe the cohort. We performed mixed effects logistic regression models with random intercept for hospital to assess for factors associated with SMM events and ICU admission. P <0.05 was considered statistically significant.
Results:
We included 2146 patients who had PAS and hysterectomy codes in the analysis. SMM events (excluding hysterectomy) occurred in 54% of cases, non-transfusion SMM events in 25% of cases and a transfusion SMM in 44% of cases. 45% of cases were admitted to ICU. In the multivariable model, the following factors were associated with SMM excluding hysterectomy and eclampsia: placenta percreta [OR 1.79, 95% CI, 1.37- 2.34], other race (not including Asian, Black or White) [OR 1.51, 95% CI, 1.08-2.11], chronic lung diseases [ OR 1.49, 95% CI, 1.03- 2.15, coagulopathy [OR 1.51, 95% CI, 1.02-2.24], eclampsia [29.88, (3.33, 268.39), p=0.019], neuraxial anesthesia compared with general anesthesia [OR 0.27, 95% CI, 0.16, 0.44], year of admission [OR 0.75, 95% CI, 0.69- 0.80], as well as second [OR 0.64, 95% CI, 0.44, 0.94] and fourth [OR 0.48, 95% CI, 0.27-0.85] quartile of PAS case volume as compared to first quartile. The following variables were associated with ICU admission: placenta percreta [OR 1.68, 95% CI, 1.21-2.33], transfusion SMM [OR 11.97, 95% CI, 9.07-15.81], coagulopathy [OR 2.96, 95% CI, 1.77-4.95], neuraxial anesthesia [OR 0.43, 95% CI, 0.27-0.68], year of admission [OR 0.44, 95% CI, 0.27, 0.68], hospitals with 0-99 beds [OR 0.30, 95% CI, 0.11-0.87], 100-199 beds [OR 0.38, 95% CI, 0.17-0.85], 200-299 beds [OR 0.32, 95% CI, 0.15-0.71], 300-399 beds [OR 0.44 95% CI, 0.23-0.84] compared with >=500 hospital beds, and deficiency anemia [OR 0.51, 95% CI 0.32-0.81].
Conclusion:
SMM events were common in this patient population with transfusion SMM being the most common. Almost half of the patients in this cohort were admitted to the ICU postoperatively, with transfusion SMM being the strongest factor in our study associated with ICU admission.
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