Retrospective comparison of emergent versus scheduled peripartum hysterectomies: a single institution experience

Objectives: The objective of this study was to compare outcomes between scheduled and emergent peripartum hysterectomies at our institution, particularly those completed for abnormal placentation, to provide insight for perioperative optimization. Methods: Retrospective analysis of all peripartum hysterectomies completed at a single center over a five-year period. Antepartum, intraoperative, and post-operative courses were reviewed. Patients were categorized based on whether surgery was performed urgently/emergently or scheduled. Bivariate analysis was performed to compare demographic, pre-, intra-, and post-operative outcomes between urgent/emergent and scheduled hysterectomy groups. Results: Among 49 peripartum hysterectomies completed between 2015-2019, 13 (26.5%) were emergent and 36 (73.5%) were scheduled. All were completed following a cesarean delivery. Baseline demographic characteristics were not different between the groups. Surgical indication included abnormal placentation (86.1%) and carcinoma (11.1%) for scheduled cases and abnormal placentation (46.2%), uterine atony (30.7%), uterine rupture (7.7%), and surgical complication (23.1%) for emergent cases. A gynecologic oncologist was involved in 34 cases (69.4%) with their presence significantly more common in scheduled cases (80.7% vs 38.5%, p=0.005). Of cases completed for abnormal placentation, 30 were scheduled and 5 were emergent. Rate of gynecologic oncology involvement was similar between these two groups (80.0% vs 60.0%, p=0.57). Thirty-four (97%) of these cases were complicated by intra-operative hemorrhage with emergent cases having higher average blood loss (7.2L vs 3.0L, p=0.30). There were two bladder injuries and one vascular injury (all occurred in scheduled cases). There were no ureteral of bowel injuries. Emergent cases had higher rates of ICU stay (80.0% vs 55.2%, p=0.38), while scheduled cases had higher rates of post-operative transfusion (30% vs 0%, p=0.30) and immediate postoperative complications (26.7% vs 0%, p=0.32, Table 1). Six-week post-operative complication rates were similar between the two groups (36.7% vs 40.0%). Download : Download high-res image (60KB) Download : Download full-size image Conclusions: Scheduled peripartum hysterectomies are more common than emergent peripartum hysterectomies at our institution. Involvement of a gynecologic oncologist is common, particularly for scheduled and abnormal placentation cases. Amongst abnormal placentation cases, we observed high rates of intra-operative and post-operative complications. Abnormal placentation cases completed in an emergent setting had intra-operative blood loos as well as need for ICU stay. Implementation of multidisciplinary protocols, particularly in the emergent setting, may help to address these differences and minimize morbidity.