目的:评估(i)临床和妊娠特征,(ii)外科手术的模式,和(iii)根据主治医生的专业,与剖宫产子宫切除术治疗胎盘植入谱相关的手术发病率。
方法:回顾性查询了PremierHealthcare数据库,以研究2016年至2020年期间行剖宫产和子宫切除术的胎盘植入谱患者。根据子宫切除术的外科医生专业,使用倾向评分治疗加权的逆概率评估手术发病率:普通妇产科医生,母胎医学专家,和妇科肿瘤学家.
结果:共2240例剖宫产子宫切除术。最常见的外科医生类型是普通妇产科医生(n=1534,68.5%),其次是妇科肿瘤专家(n=532,23.8%)和母胎医学专家(n=174,7.8%).妇科肿瘤医师组的患者胎盘植入或胎盘植入率最高,其次是母胎医学专家和普通妇产科医生组(43.4%,39.6%,和30.6%,P<.001)。在倾向得分加权模型中,测量的手术发病率在三个亚专科组中相似,包括出血/输血(59.4-63.7%),膀胱损伤(18.3-24.0%),输尿管损伤(2.2-4.3%),震荡(8.6-10.5%),和凝血功能障碍(3.3-7.4%)(全部,P>.05)。在妇科肿瘤科医生进行的剖宫产子宫切除术中,尽管进行了额外的外科手术,但出血/输血率仍然很高:氨甲环酸/输尿管支架(60.4%),氨甲环酸/动脉内手术(76.2%),输尿管支架/动脉内手术(51.6%),和所有三个程序(55.4%)。氨甲环酸与输尿管支架置入术与膀胱损伤减少相关(12.8%vs23.8-32.2%,P<.001)。
结论:这些数据表明,与胎盘植入的剖宫产子宫切除术相关的患者特征和手术方式因外科医生的专业而异。妇科肿瘤学家似乎可以处理更严重的胎盘植入谱。不管外科医生的专业,剖宫产子宫切除术对胎盘植入频谱的手术发病率显著。
To assess (i) clinical and pregnancy characteristics, (ii) patterns of surgical procedures, and (iii) surgical morbidity associated with cesarean hysterectomy for placenta accreta spectrum based on the specialty of the attending surgeon.
The Premier Healthcare Database was queried retrospectively to study patients with placenta accreta spectrum who underwent cesarean delivery and concurrent hysterectomy from 2016 to 2020. Surgical morbidity was assessed with propensity score inverse probability of treatment weighting based on surgeon specialty for hysterectomy: general obstetrician-gynecologists, maternal-fetal medicine specialists, and gynecologic oncologists.
A total of 2240 cesarean hysterectomies were studies. The most common surgeon type was general obstetrician-gynecologist (n = 1534, 68.5%), followed by gynecologic oncologist (n = 532, 23.8%) and maternal-fetal medicine specialist (n = 174, 7.8%). Patients in the gynecologic oncologist group had the highest rate of placenta increta or percreta, followed by the maternal-fetal medicine specialist and general obstetrician-gynecologist groups (43.4%, 39.6%, and 30.6%, P < .001). In a propensity score-weighted model, measured surgical morbidity was similar across the three subspecialty groups, including hemorrhage / blood transfusion (59.4-63.7%), bladder injury (18.3-24.0%), ureteral injury (2.2-4.3%), shock (8.6-10.5%), and coagulopathy (3.3-7.4%) (all, P > .05). Among the cesarean hysterectomy performed by gynecologic oncologist, hemorrhage / transfusion rates remained substantial despite additional surgical procedures: tranexamic acid / ureteral stent (60.4%), tranexamic acid / endo-arterial procedure (76.2%), ureteral stent / endo-arterial procedure (51.6%), and all three procedures (55.4%). Tranexamic acid administration with ureteral stent placement was associated with decreased bladder injury (12.8% vs 23.8-32.2%, P < .001).
These data suggest that patient characteristics and surgical procedures related to cesarean hysterectomy for placenta accreta spectrum differ based on surgeon specialty. Gynecologic oncologists appear to manage more severe forms of placenta accreta spectrum. Regardless of surgeon\'s specialty, surgical morbidity of cesarean hysterectomy for placenta accreta spectrum is significant.