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- W3127965308 abstract "The optimal strategy for surgical management of morbidly adherent placenta (MAP) continues to evolve. Here, we assess the impact of a standardized, single-specialty surgical workflow on outcomes for women undergoing cesarean hysterectomy (C-hyst) for MAP. After obtaining IRB permission, all women who underwent C-hyst for MAP on a high-volume obstetrical service over a 10-year timespan were identified. Clinical demographics were retrospectively abstracted. Outcomes before and after implementation of the standardized workflow were compared. Statistical significance was assessed using two-tailed Student’s and Chi-squared tests. A total of 100 subjects with mean age of 32 + 5.1 year and median BMI of 31.8 (Range: 19.6 - 54.9) were identified. Most (n=94) reported prior cesarean section or myomectomy. Most pregnancies (n=62) had been complicated by placenta previa. When compared to their counterparts, women who underwent C-hyst following surgical standardization (n=48) were less likely to prophylactically receive ureteral stents (n=1 vs 36) or endovascular balloons (n=0 vs. 7). Despite this, they experienced significantly less blood loss (mean: 1,974 vs 3,180 ml; p=0.02) and shorter mean operative times (138 vs 194 min, p=0.004). The only ureterotomy occurred in a subject with ureteral stents who underwent C-hyst prior to standardization. Five C-hysts were abandoned in favor of conservative management prior to protocol implementation. No differences in the number of bladder injuries (n=12 each), oophorectomies (n=1 vs 5), re-operation (n=2 vs 6) or mean length postoperative stay (5.0 vs 6.7 days, p=0.12) were observed. No differences in mean age, BMI, race, ethnicity, or number of prior c-sections were observed between the two groups. Implementation of a standardized surgical workflow for MAP is associated with improved clinical outcomes with reduced consumption of resources. Further investigation should focus on elements of this workflow potentially suitable for broadly supporting MAP care." @default.
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- W3127965308 date "2021-02-01" @default.
- W3127965308 modified "2023-09-27" @default.
- W3127965308 title "914 Impact of a standardized surgical workflow on outcomes of hysterectomy performed for morbidly adherent placenta" @default.
- W3127965308 doi "https://doi.org/10.1016/j.ajog.2020.12.939" @default.
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