(461) Adverse outcomes and postpartum readmissions following peripartum hysterectomy among placenta accreta spectrum subtypes

Using the 2016-2019 Nationwide Readmission Database, peripartum hysterectomies with a diagnosis of PASD were identified. The primary exposure was PASD, categorized as placenta accreta versus increta/percreta. Outcomes of interest included (i) risk for delivery complications including non-transfusion severe maternal morbidity (ntSMM) based on CDC criteria, venous thromboembolism, reoperation, intraoperative complications, hemorrhage, sepsis, and surgical site complications, and (ii) risk for 60-day all cause postpartum readmission. Unadjusted and adjusted logistic regression models were fit for all the outcomes adjusting for clinical, demographic, and hospital factors were conducted to assess these outcomes using unadjusted/adjusted odds ratios (OR/aOR) with 95% confidence intervals (CI). 

Results:

Between 2016 and 2019, 5,427 cesarean hysterectomies for PAS were identified (66.0% accreta, 17.6% increta, and 16.4% percreta). The overall 60-day all-cause readmission rate was 7.5%.  The majority of readmissions (57.2%) occurred within 10 days of hospital discharge regardless of PAS subtype (Figure). Compared to accretas, incretas/percretas carried significantly increased risk of 60-day readmission (aOR 1.44, 95% CI 1.07, 1.92)), ntSMM (aOR 1.44, 95% CI 1.18, 1.76), intraoperative complications (aOR 2.39, 95% CI 1.91, 2.98), and surgical site complications (aOR 1.58, 95% CI 1.22, 2.03) (Table).

Conclusion: Readmission risk after peripartum hysterectomy with PASD is high. Patients with increta and percreta were at highest risk for both delivery complications and postpartum readmission.