Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta

Abstract

To compare outcomes of patients with placenta accreta who had intravascular balloon catheters placed prior to cesarean hysterectomy versus controls managed with hysterectomy alone. Case-control study of patients with preoperatively diagnosed placenta accreta identified using hospital databases and billing records at UCI and Long Beach Memorial Medical Centers from January 1995 to January 2006. Patients with preoperative intravascular balloon catheter (BC) placement plus hysterectomy were compared to those that had hysterectomy (H) alone. Primary outcomes evaluated were EBL, need for transfusion, length of surgery, and post-operative hospital days. Secondary outcomes included development of DIC, post-operative ileus, wound complications, febrile morbidity, and complications related to balloon catheter placement. Sixty-nine patients had cesarean hysterectomy performed for abnormal placentation; 19 patients had balloon catheters plus hysterectomy and 50 patients had hysterectomy alone. No significant differences were noted in EBL [(BC) 2700 (range 800-8000cc) vs. (H) 3000 (range 600-7000cc); p = 0.79], transfused blood products [(BC) 10 (range 0-43 units) vs. (H) 6.5 (range 0-54 units); p = 0.60], operative time [(BC) 182 (range 110-360 min) vs. (H) 180 (range 60-420 min); p = 0.85], and post-operative hospital days [(BC) 5 (4-11 days) vs. (H) 4 (range 3-44 days); p = 0.85]. There were no significant differences in secondary outcomes between groups. Three of 19 (15.8%) BC patients had complications from catheter placement; two required stent placement and arterial bypass. This is the largest case-control report of cesarean hysterectomy with and without prophylactic intravascular balloon catheter placement for placenta accreta. We failed to demonstrate any benefit in primary surgical outcomes or in associated co-morbidities when the catheters were placed pre-operatively. In addition, we report severe complications resulting directly from catheter placement in 3 of 19 patients.