Outcomes associated with peripartum hysterectomy in the setting of placenta accreta spectrum disorder

Background: While peripartum hysterectomy for placenta accreta spectrum disorder (PASD) is known to be associated with complications at the time of delivery, there is limited data on postpartum outcomes and readmission risk in this population.Objective: To analyze risks for adverse outcomes and postpartum readmissions in the setting of peripartum hysterectomy for PASD by severity of PASD subcategory.Study design: Using the 2016-2020 Nationwide Readmission Database, this retrospective cohort study identified peripartum hysterectomies with a diagnosis of PASD. The primary exposure was PASD, subcategorized as placenta accreta versus increta/percreta. The primary outcome was readmission rate and delivery complications. Complications evaluated included (i) non-transfusion severe maternal morbidity (ntSMM), (ii) venous thromboembolism, (iii) reoperation, (iv) intraoperative complications, (v) hemorrhage, (vi) sepsis, and (vii) surgical site complications. We additionally evaluated delivery hospitalization and readmission mean length of stay, and hospital costs. Unadjusted and adjusted logistic regression models were fit for outcomes adjusting for clinical, demographic, and hospital factors with unadjusted and adjusted odds ratios (OR and aORs, respectively) with 95% confidence intervals (CI) as measures of association.Results: Between 2016 and 2020, 7,864 hysterectomies during a delivery hospitalization with a diagnosis of PASD were identified (66.5% with accreta, 33.5% with increta/percreta diagnoses). The overall 60-day all-cause readmission rate was 7.3%. The majority of readmissions (57.2%) occurred within 10 days of hospital discharge. Compared to peripartum hysterectomy with a diagnosis of accreta, hysterectomies with increta/percreta diagnoses carried significantly increased risk of 60-day readmission (aOR 1.31, 95% CI 1.01-1.71), inpatient mortality (OR 13.23, 95% CI 3.35, 52.30), ntSMM (aOR 1.43, 95% CI 1.20, 1.71), intraoperative complications (aOR 2.31, 95% CI 1.93, 2.77), and surgical site complications (aOR 1.55, 95% CI 1.23, 1.95). The median length of stay during delivery hospitalization was longer for increta/percreta (5.8 days, 95% CI 5.4, 6.1) than accreta (4.2 days, 95% CI 4.1, 4.3) (p < .05). Additionally, delivery hospitalization costs were higher in cases of increta/percreta (median $30,686, 95% CI $28,922, $32,449) than accreta (median $21,321, 95% CI: $20,480, $22,163).Conclusions: Complication and readmission risks after peripartum hysterectomy with PASD are high. Patients with placenta increta/percreta were at highest risk for delivery and postoperative complications, postpartum readmission, and increased costs and length of stay.