Authors: Padilla A et al.
Journal: Anesthesiology, December 16, 2025. DOI: 10.1097/ALN.0000000000005788
Summary
This multicenter retrospective cohort study examined contemporary anesthetic practice patterns for cesarean hysterectomy in patients with placenta accreta spectrum across U.S. hospitals. Using the Multicenter Perioperative Outcomes Group database, the investigators sought to characterize modes of anesthesia and identify clinical factors associated with the planned anesthetic approach for the hysterectomy portion of care.
The analysis included 1,257 cesarean hysterectomy cases from 43 institutions between 2015 and 2021. Anesthetic management varied substantially, reflecting the complexity and heterogeneity of placenta accreta spectrum. Neuraxial anesthesia with planned or unplanned conversion to general anesthesia was the most common approach, accounting for just over 40% of cases. General anesthesia alone was used in one-third of patients, while neuraxial anesthesia without conversion was used in approximately one-quarter.
More invasive placental pathology was strongly associated with use of general anesthesia. Patients with placenta increta or percreta had more than twice the odds of receiving general anesthesia compared with those with accreta. Unscheduled procedures and higher American Society of Anesthesiologists Physical Status classifications were also independently associated with planned general anesthesia, highlighting the influence of physiologic reserve and clinical urgency on anesthetic decision-making.
Overall, the findings underscore that anesthetic management for placenta accreta spectrum is highly individualized and varies widely across institutions. The authors emphasize the need for future studies linking anesthetic technique to maternal morbidity, recovery, and patient-centered outcomes to better guide evidence-based anesthetic planning in this high-risk population.
Key Points
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Neuraxial anesthesia with conversion to general anesthesia was the most common approach for cesarean hysterectomy in placenta accreta spectrum.
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One-third of patients received primary general anesthesia, while one-quarter underwent neuraxial anesthesia alone.
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Placenta increta and percreta were strongly associated with planned general anesthesia.
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Unscheduled surgery and higher ASA Physical Status increased the likelihood of general anesthesia.
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Considerable inter-hospital variation highlights the need for outcome-driven guidance on anesthetic choice.
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