Mode of Anesthesia for Patients with Placenta Accreta Spectrum Undergoing Cesarean Hysterectomy: A Report from the Multicenter Perioperative Outcomes Group Database.

BACKGROUND

Placenta accreta spectrum is a highly morbid obstetric condition, often necessitating cesarean hysterectomy and requiring specialist anesthesia care. There are few hospital-level data describing anesthetic management of these cases. The authors performed this study to describe anesthetic modalities for these cases across a cohort of U.S. hospitals.

METHODS

The authors performed a retrospective cohort study using the Multicenter Perioperative Outcomes Group database and identified patients who underwent cesarean hysterectomy for placenta accreta spectrum between January 1, 2015, and December 31, 2021. The primary outcome was mode of anesthesia, classified as general anesthesia, neuraxial anesthesia, or neuraxial with conversion to general anesthesia. Descriptive statistics were used to describe the cohort. A mixed effects logistic regression model was fit for the intended anesthetic technique for the hysterectomy portion of the procedure (general or neuraxial) for suspected placenta accreta spectrum. Patients who received both were classified according to whether the conversion was planned (classified as general) or unplanned (classified as neuraxial).

RESULTS

The authors identified 1,257 cases from 43 institutions. Of those, 418 (33.3%) received general anesthesia, 333 (26.5%) received neuraxial anesthesia, and 506 (40.3%) received neuraxial anesthesia with conversion to general anesthesia. In the multivariable model, placenta percreta versus accreta (odds ratio [OR], 2.14 [95% CI, 1.33 to 3.44]), increta vs . accreta (OR, 2.04 [95% CI, 1.25 to 3.34]), unscheduled vs . scheduled cases (OR, 3.28 [95% CI, 2.04 to 5.26]), American Society of Anesthesiologists (Schaumburg, Illinois) Physical Status III vs . II (OR, 1.57 [95% CI, 1.02 to 2.40]), and American Society of Anesthesiologists Physical Status IV vs . II (OR, 2.95 [95% CI, 1.51 to 5.74]) were associated with higher odds of general anesthesia for the hysterectomy for suspected placenta accreta spectrum.

CONCLUSIONS

Neuraxial anesthesia followed by conversion to general anesthesia was the most common choice for cesarean hysterectomy. Future studies should evaluate maternal morbidity and recovery after various modes of anesthesia to help refine decision-making for the choice of anesthetic technique.