441: Readmission risk after cesarean hysterectomy based on the presence or absence of placenta accreta

Abstract

There is limited data on risk for readmission and associated complications after deliveries involving peripartum hysterectomy. Additionally, whether or not placenta accreta spectrum (PAS) was present at delivery may be an important prognostic factor for complications. The objective of this analysis was to determine readmission risk and risk for associated severe maternal morbidity (SMM) after peripartum hysterectomy in the presence and absence of PAS. Cesarean hysterectomies were identified from the 2010-2014 Nationwide Readmissions Database. Subsequent readmissions within 60 days from delivery hospitalization discharge were ascertained and stratified by the presence of PAS. Multivariable log linear regression models were fit to evaluate for 60-day all cause readmission with the primary exposure of PAS. A subsequent model was fit for readmissions complicated by SMM based on criteria from the Centers for Disease Control and Prevention. All models were adjusted by demographic, hospital, and clinical factors. We identified 13,892 cesarean hysterectomies with 11% of cases classified as PAS. Delivery length of stay did not differ statistically by PAS status (non-PAS: 7.9 days, PAS: 8.8 days, p >0.05). Risk for readmission was 4.4% after peripartum hysterectomy complicated by PAS (68/1541) and 6.4% after peripartum hysterectomy without PAS (793/12,351) (p< 0.01). ≥50% of readmissions occurred ≤10 days after discharge for peripartum hysterectomies with and without PAS (Figure 1). In adjusted analysis, peripartum hysterectomy PAS was associated with 29% lower risk of readmission compared to non-PAS (Table 1). However, PAS was associated with twice the risk for readmission complicated by SMM. Among patients requiring cesarean hysterectomy, women with PAS are at lower risk of readmission but significantly elevated risk for development of severe maternal morbidity when readmitted. Further analysis to determine specific risk factors for readmission and severe morbidity complications may help guide clinical management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)