TY - JOUR
T1 - Neuraxial to general anesthesia conversion has equitable intraoperative and improved post-operative outcomes compared to general anesthesia in cesarean hysterectomy for placenta accreta spectrum (PAS)
AU - Munoz, Jessian L.
AU - Pfeiffer, Alixandria F.
AU - Curbelo, Jacqueline
AU - Ramsey, Patrick S.
AU - Ireland, Kayla E.
N1 - Publisher Copyright:
© 2021 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2022
Y1 - 2022
N2 - Objective: Placenta Accreta Spectrum (PAS) represents a series of placental disorders with an estimated incidence of 1:1000. Delivery and subsequent cesarean hysterectomy for PAS is associated with significant maternal morbidity and mortality. Neuraxial anesthesia may be utilized initially with subsequent conversion to general anesthesia after delivery of the fetus as an alternative to initiating with general anesthesia. Methods: We performed a case–control study and analyzed 85 cases of pathology-confirmed PAS patients who underwent a cesarean hysterectomy in singleton, non-anomalous, viable pregnancies. All patients were delivered at our institution’s established Placenta Accreta Program from 2005 to 2020. Results: Fifty-two (61%) patients underwent general anesthesia and 33 (39%) patients underwent neuraxial anesthesia (collectively spinal, epidural, and combined spinal-epidural) converted to general anesthesia after cesarean delivery. Baseline demographics between groups were similar. Pre-operative ASA airway assessment of III/IV was equivalent between groups (94 and 82%, p =.08). Intraoperatively, neuraxial conversion and general anesthesia were equal with respect to operative time (241 vs. 261 min, p =.47), estimated blood loss (6039 vs. 8134 mL, p =.51), and composite maternal morbidity (84.6 vs. 75.8%, p =.40). Post-operatively, ICU admission (47 vs. 46%, p = 1.0) and intensive care length of stay was equivalent (p =.07), yet the total post-operative length of stay was significantly reduced in patients who underwent neuraxial anesthesia (3.76 vs. 6.35 days, p =.02). In addition, while general anesthesia was associated with a greater sonographic suspicion for placenta percreta (40 vs. 12%, p =.007), final pathology was equivalent (52 vs. 60%, p =.5). Conclusions: Taken together, our data show neuraxial conversion to general anesthesia has equivalent intra-operative parameters with improved post-operative outcomes when compared to general anesthesia alone in the case of cesarean hysterectomy for Placenta Accreta Spectrum disorders.
AB - Objective: Placenta Accreta Spectrum (PAS) represents a series of placental disorders with an estimated incidence of 1:1000. Delivery and subsequent cesarean hysterectomy for PAS is associated with significant maternal morbidity and mortality. Neuraxial anesthesia may be utilized initially with subsequent conversion to general anesthesia after delivery of the fetus as an alternative to initiating with general anesthesia. Methods: We performed a case–control study and analyzed 85 cases of pathology-confirmed PAS patients who underwent a cesarean hysterectomy in singleton, non-anomalous, viable pregnancies. All patients were delivered at our institution’s established Placenta Accreta Program from 2005 to 2020. Results: Fifty-two (61%) patients underwent general anesthesia and 33 (39%) patients underwent neuraxial anesthesia (collectively spinal, epidural, and combined spinal-epidural) converted to general anesthesia after cesarean delivery. Baseline demographics between groups were similar. Pre-operative ASA airway assessment of III/IV was equivalent between groups (94 and 82%, p =.08). Intraoperatively, neuraxial conversion and general anesthesia were equal with respect to operative time (241 vs. 261 min, p =.47), estimated blood loss (6039 vs. 8134 mL, p =.51), and composite maternal morbidity (84.6 vs. 75.8%, p =.40). Post-operatively, ICU admission (47 vs. 46%, p = 1.0) and intensive care length of stay was equivalent (p =.07), yet the total post-operative length of stay was significantly reduced in patients who underwent neuraxial anesthesia (3.76 vs. 6.35 days, p =.02). In addition, while general anesthesia was associated with a greater sonographic suspicion for placenta percreta (40 vs. 12%, p =.007), final pathology was equivalent (52 vs. 60%, p =.5). Conclusions: Taken together, our data show neuraxial conversion to general anesthesia has equivalent intra-operative parameters with improved post-operative outcomes when compared to general anesthesia alone in the case of cesarean hysterectomy for Placenta Accreta Spectrum disorders.
KW - Placenta accreta
KW - abnormal placentation
KW - anesthesia
KW - cesarean hysterectomy
KW - neuraxial anesthesia
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U2 - 10.1080/14767058.2021.1990885
DO - 10.1080/14767058.2021.1990885
M3 - Article
C2 - 34657560
AN - SCOPUS:85118167595
SN - 1476-7058
VL - 35
SP - 8640
EP - 8644
JO - Journal of Maternal-Fetal and Neonatal Medicine
JF - Journal of Maternal-Fetal and Neonatal Medicine
IS - 25
ER -