Effect of Race and Insurance on Outcomes in Women With Placenta Accreta Spectrum [ID: 1374697

Abstract

INTRODUCTION: We evaluated whether maternal race and insurance status affect outcomes in pregnancies diagnosed with placenta accreta spectrum (PAS). METHODS: This was an IRB-approved retrospective cohort study including women diagnosed with PAS from January 2013 to December 2021 at a single academic institution. Women were grouped based on race and insurance status. Primary outcome was intraoperative complications including PPH, uterine rupture, cystotomy, and ureteral injury. Secondary outcomes included total blood products, length of stay, and postdischarge complications (readmission, infection, disseminated intravascular coagulation, and venous thromboembolism). Statistical analysis was performed using χ2 tests, Student t tests, and logistic regression modeling, with statistical significance defined as P<.05. RESULTS: A total of 72 pregnancies with PAS were included. The majority of patients were Caucasian (69.0%), followed by Hispanic (14.1%), African American (11.3%), Asian/Pacific Islander (2.8%), and other (2.8%). 27 women (37.5%) had government-assisted insurance. There was no association between race and preoperative multidisciplinary planning (P=.223), planned hysterectomy (P=.926), or composite of any intraoperative complications (P=.141). Race did not predict receiving greater than five blood products (P=.623), ICU admission (P=.447), or composite of any postdischarge complication (P=.103). Similarly, there was no association with the above outcomes based on insurance status. Government-assisted insurance did predict length of stay greater than 7 days (85.7% versus 14.3%, P=.010). CONCLUSION: At our institution, maternal race and health insurance status did not affect preoperative planning, perioperative resuscitation, and delivery outcomes in women with PAS.