Perioperative outcomes with maternal fetal medicine specialist as primary surgeon for placenta accreta spectrum hysterectomies

Objective: To examine surgical and perioperative outcomes following peripartum hysterectomy in a multidisciplinary placenta accreta spectrum (PAS) program with maternal fetal medicine specialist as primary surgeon. Study Design: This is a retrospective cohort study comparing surgical and perioperative outcomes of PAS hysterectomy patients in a Pre-Program cohort versus a Post-Program cohort in a large regional perinatal center. All participants received a peripartum hysterectomy at delivery with confirmed pathologic diagnosis for PAS. The primary outcome was packed red blood cell (PRBC) utilization. Secondary outcome measures were intraoperative resuscitation needs, intraoperative and postoperative complications, intraoperative surgeon consultation, and indicators of severe maternal morbidity. Results: 145 pathology confirmed PAS and peripartum hysterectomy specimens were included: 58 Pre-Program (2008-2017) and 87 Post-Program (2018-2024). MFM as primary surgeon differed between the Pre- and Post- Program cohorts (17.2% vs 93.1%). When adjusted for “Urgency of Case” (scheduled and expected, unscheduled and expected, emergent/unexpected), there was a significant decrease in PRBC (IRR 0.51, 95% CI [0.45, 0.58]) IRR, 95% CI 0.67[CI -0.80,-0.55]) and estimated blood loss (IRR 0.55, 95% CI [0.54, 0.55]) when comparing Post-Program to Pre-Program groups. There were also decreases in intensive care unit admission (13 [14.9%] vs 26 [44.8%], P<.001), Urologic consultations (9 [15.5%] vs 4 [4.7%], P=.037), postoperative ileus (6 [10.3%] vs 5 [5.7%], P=.033), and postoperative length of stay (4 [3,5] vs 5 [4,7], P=.001). Conclusion: A multidisciplinary PAS program using MFMs as primary surgeons for peripartum hysterectomy were a viable and non-inferior. Further, there were improved surgical and perioperative outcomes with program formation similar to traditional strategies utilizing advanced pelvic surgeons, like gynecologic oncologists.