Mode of Anesthesia for Patients with Placenta Accreta Spectrum Undergoing Cesarean Hysterectomy: A Report from the Multicenter Perioperative Outcomes Group Database

Padilla, A; Stockinger, J; Zanolli, NC; Hurwitz, R; Ende, HB; Butwick, AJ; Warrick, CM; Hess, PE; Mathis, M; Fuller, M; Habib, AS; Multicenter Perioperative Outcomes Group Investigators

doi:10.1097/aln.0000000000005788

Obstetric anesthesia

Mode of Anesthesia for Patients with Placenta Accreta Spectrum Undergoing Cesarean Hysterectomy: A Report from the Multicenter Perioperative Outcomes Group Database

AnesthesiologyPublished 6 Oct 2025Retrospective cohort study

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Authors' conclusion

Neuraxial anesthesia followed by conversion to general anesthesia was the most common choice for cesarean hysterectomy.

Study context

Population: Patients undergoing cesarean hysterectomy for placenta accreta spectrum, Multicenter Perioperative Outcomes Group database, US hospitals, 2015–2021
Participants: 1,257 patients · 43 institutions

Exposure: Mode of anesthesia: GA vs neuraxial vs neuraxial with conversion to GA
General anesthesian = 418
Neuraxial anesthesian = 333
Neuraxial with conversion to GAn = 506
Outcome: Mode of anesthesia (GA, neuraxial, or neuraxial with conversion to GA)

Methodological detailsmulticentre registry, mixed effects logistic regression

Multicentre registry
Mixed effects logistic regression

Main finding

As reported in the abstract

Mode of anesthesia

General anesthesia33.3%418

Neuraxial anesthesia26.5%333

Neuraxial with conversion to GA40.3%506

Observational data: associations, not effects.

Further findings

Outcome	← Lower odds ←→ Higher odds →	OR (95% CI)
Factors associated with intended GA for hysterectomy (multivariable model)Placenta percreta vs Accreta	0.20.5125	2.14 (1.33–3.44)
Factors associated with intended GA for hysterectomy (multivariable model)Increta vs Accreta	0.20.5125	2.04 (1.25–3.34)
Factors associated with intended GA for hysterectomy (multivariable model)Unscheduled vs Scheduled	0.20.5125	3.28 (2.04–5.26)
Factors associated with intended GA for hysterectomy (multivariable model)ASA Physical Status III vs ASA II	0.20.5125	1.57 (1.02–2.40)
Factors associated with intended GA for hysterectomy (multivariable model)ASA Physical Status IV vs ASA II	0.20.5125	2.95 (1.51–5.74)
	0.20.5125Odds ratio (log scale)

Factors associated with intended GA for hysterectomy (multivariable model): planned conversion classified as general, unplanned as neuraxial

Original publication

Mode of Anesthesia for Patients with Placenta Accreta Spectrum Undergoing Cesarean Hysterectomy: A Report from the Multicenter Perioperative Outcomes Group Database. Anesthesiology. Published 6 October 2025. doi:10.1097/aln.0000000000005788

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