(688) Impact of skin incision type on operative morbidity in cesarean hysterectomy for placenta accreta spectrum

Vertical skin incision is often used for a planned cesarean hysterectomy (C-Hyst) for its improved visualization and conceivably fewer surgical complications. This study was designed to determine whether surgical complications for planned C-Hyst differ by skin incision type.

Study Design:

Cohort study of patients with planned C-Hyst for placenta accreta spectrum (PAS) stratified by skin incision (LT or vertical) from 2012-2023. Primary outcome was a composite of transfusion ≥ 4 units, intraoperative bowel or bladder injury, intensive care unit admission or wound complication. Comparisons performed using χ², t-test, rank sum test and multivariable logistic regression as appropriate.

Results:

We identified 53 patients with planned C-Hyst for PAS, of whom 37 (70%) had LT skin incision and 16 (30%) had vertical skin incision. Patients with LT incision were more likely to be ≥ 35 years old (76% vs 44%, P=0.02), have an antenatal diagnosis of accreta only (68% vs 38%, P=0.04) and deliver at a later gestational age (34.9 vs 33.7 weeks, P=0.01). The primary composite outcome was less common in those with LT incision than vertical incision (62% vs 94%, P=0.02). After adjusting for potential confounders, the odds of the primary outcome were the same (aOR 8.2, CI 0.8-89). However, vertical incision was more likely to have estimated blood loss ≥ 2500 cc (aOR 6.9, CI 1.2-38.5), operative time ≥ 120 minutes (aOR 8.9, CI 1.6-49.3) and discharge home with Foley catheter (aOR 13, CI 1.8-95.6), Table 1. There were no differences in wound complications, pain scores, opioid use or postpartum length of stay. There were also no differences in outcomes by skin incision when restricting the analysis to patients with percreta (8 LT incision; 4 vertical incision).

Conclusion:

Vertical skin incision at time of planned C-Hyst for PAS is associated with higher blood loss, longer operative time and prolonged Foley catheter use as compared to LT incision, without a reduction in operative complications. For a surgeon skilled at either approach, LT skin incision should be considered a safe and effective option for treating PAS.