Abstract / Summary
OBJECTIVE: To evaluate outcomes of patients with placenta accreta spectrum (PAS) managed by an OBGYN hospitalist-led multidisciplinary team. METHODS: A retrospective review was conducted evaluating the outcomes of 53 patients with PAS undergoing planned cesarean hysterectomy. Patients were managed by an OBGYN hospitalist-led multidisciplinary team from January 2024 to December 2025 in a single tertiary care center. Patients with undiagnosed PAS and those not managed by the dedicated OBGYN hospitalist team were excluded from this analysis. Data was then compared to outcomes from PAS Centers of Excellence. RESULTS: Fifty-four patients were managed by the PAS team during the study period. Four patients were considered low risk preoperatively and underwent cesarean delivery alone, while 49 had a confirmed diagnosis of PAS. On pathologic evaluation, 58% (31/53) were found to have higher-severity disease (FIGO Grade 2 or 3). Operative time ranged from 52 to 236 minutes, with a mean duration of 130.5 minutes. Quantitative blood loss (QBL) ranged from 118 to 6,000 mL, with a median of 802 mL. Eighty-five percent of patients did not require any blood products. Eight patients (15%) required blood transfusion, receiving a mean of 2.6 units per transfused patient; seven of these patients (87.5%) had FIGO Grade 2 or 3 disease. Two cystotomies occurred, and one patient required a one-day postoperative intensive care unit (ICU) stay following a multi-unit, multi-product transfusion. No patients experienced severe morbidity or mortality, and none required interventional radiologic procedures. Mean length of stay was 3.5 days. Outcomes at our center were favorable compared with those reported by PAS Centers of Excellence. The distribution of pathologic severity at our center and those of three of the PAS Centers of Excellence had fairly equal proportions of PAS Grade 1, Grade 2, and Grade 3 pathology. In contrast, two PAS Centers of Excellence reported predominantly PAS Grade 1 pathology (70–78%). Median QBL at our center was 802 mL. Median QBL reported by PAS Centers of Excellence ranged from 1,000 mL to 2,500 mL. ICU utilization was notably favorable at our center, with only one admission (1.8%). Two PAS Centers of Excellence reported their ICU admission rates of 31% (49 admissions) and 40% (18 admissions). Our center demonstrated an intraoperative complication rate of 3.8%, and the only PAS Center of Excellence that reported this outcome had an intraoperative complication rate of 37.3%. Postoperative complication rate at our center was 3.8%, and postoperative complication rates at the PAS Centers of Excellence that published this data ranged from 3.7% to 4.2%. CONCLUSION: An OBGYN hospitalist-led multidisciplinary team can effectively and safely manage complex PAS cases with favorable outcomes with low morbidity, similar to those reported from other PAS Centers of Excellence with traditional structure.