Recommended Citation
Snead K, Schreiber S, Pathare R, Harrison R, Holmgren C. Impact of Obesity on Placenta Accreta Spectrum Subjects Undergoing Hysterectomy in a Large National Cohort. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
Patients with placenta accreta spectrum (PAS) are at risk for complications during cesarean hysterectomy. Obesity increases the risk of complications at time of delivery. There is limited data on how obesity specifically affects outcomes for PAS patients undergoing hysterectomy, and understanding this relationship could lead to improved preoperative planning and improved maternal outcomes.
Purpose:
We sought to evaluate the rates of adverse maternal outcomes among those with placenta accreta spectrum undergoing hysterectomy in patients with and without obesity.
Methods:
A retrospective cohort study utilizing the National Inpatient Sample (HCUP/AHRQ) from 2017 to 2021. Those with an ICD-10 code diagnosis PAS who underwent hysterectomy (ICD-10 procedure code for hysterectomy) were included. Those with an ICD-10 code for obesity were compared to those without. The primary outcome was a composite of severe maternal morbidity (SMM) as defined by the CDC. Secondary outcomes included gestational age at delivery, preterm delivery, maternal length of stay, hemorrhage rates, blood transfusion, disseminated intravascular coagulation, infection, wound complications, or surgical complications. The groups were compared via Student’s t-tests, chi-squared, and logistic and linear regression analyses.
Results:
A total of 1,987 subjects met inclusion criteria, of which 447 (23.0%) were identified as having obesity. Subjects with obesity were more likely to be younger, non-Hispanic black, use tobacco, be publicly insured, in the lowest quartile of income, and have hypertension, pre-gestational diabetes, and history of cesarean. On univariate analysis, those with obesity had higher rates of preterm delivery, more frequent use of cystoscopy or ureteral stent placement, and lower rates of disseminated intravascular coagulation. There was no difference in the rate of the primary composite outcome of SMM, wound complication, or any surgical complication. After controlling for confounders, there was no association between subjects with obesity and adverse outcomes in those undergoing hysterectomy for placenta accreta spectrum including risk of infection or surgical complications
Conclusions:
Obesity in PAS patients undergoing hysterectomy is not associated with adverse outcomes when controlling for confounders.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Impact of Obesity on Placenta Accreta Spectrum Subjects Undergoing Hysterectomy in a Large National Cohort
Background/Significance:
Patients with placenta accreta spectrum (PAS) are at risk for complications during cesarean hysterectomy. Obesity increases the risk of complications at time of delivery. There is limited data on how obesity specifically affects outcomes for PAS patients undergoing hysterectomy, and understanding this relationship could lead to improved preoperative planning and improved maternal outcomes.
Purpose:
We sought to evaluate the rates of adverse maternal outcomes among those with placenta accreta spectrum undergoing hysterectomy in patients with and without obesity.
Methods:
A retrospective cohort study utilizing the National Inpatient Sample (HCUP/AHRQ) from 2017 to 2021. Those with an ICD-10 code diagnosis PAS who underwent hysterectomy (ICD-10 procedure code for hysterectomy) were included. Those with an ICD-10 code for obesity were compared to those without. The primary outcome was a composite of severe maternal morbidity (SMM) as defined by the CDC. Secondary outcomes included gestational age at delivery, preterm delivery, maternal length of stay, hemorrhage rates, blood transfusion, disseminated intravascular coagulation, infection, wound complications, or surgical complications. The groups were compared via Student’s t-tests, chi-squared, and logistic and linear regression analyses.
Results:
A total of 1,987 subjects met inclusion criteria, of which 447 (23.0%) were identified as having obesity. Subjects with obesity were more likely to be younger, non-Hispanic black, use tobacco, be publicly insured, in the lowest quartile of income, and have hypertension, pre-gestational diabetes, and history of cesarean. On univariate analysis, those with obesity had higher rates of preterm delivery, more frequent use of cystoscopy or ureteral stent placement, and lower rates of disseminated intravascular coagulation. There was no difference in the rate of the primary composite outcome of SMM, wound complication, or any surgical complication. After controlling for confounders, there was no association between subjects with obesity and adverse outcomes in those undergoing hysterectomy for placenta accreta spectrum including risk of infection or surgical complications
Conclusions:
Obesity in PAS patients undergoing hysterectomy is not associated with adverse outcomes when controlling for confounders.
Affiliations
Advocate Christ Medical Center