Placenta accreta spectrum refers to a morbidly adherent placenta to the gravid uterus [1,2]. While optimal treatment is currently under active evaluation, pregnant patients with suspected placenta accreta spectrum frequently undergo hysterectomy for the en-bloc removal of in-situ placenta altogether with the uterus immediately following cesarean delivery of the fetus [1]. This surgical procedure, however, is associated with significant maternal morbidity and mortality [3]. Improving perioperative outcomes of cesarean hysterectomy for placenta accreta spectrum is therefore of utmost importance and an unmet-need for surgeons and patients.

Various approaches and surgical techniques have been proposed previously to minimize surgical morbidity of cesarean hysterectomy for placenta accreta spectrum [[4], [5], [6], [7], [8]]. Focused areas of evaluation include a multidisciplinary team approach [9,10], prophylactic ureteral stent placement [11,12], endo-arterial procedures such as uterine arterial balloon occlusion [13] and resuscitative endovascular balloon occlusion of the aorta [14], and combination of antifibrinolytic agent use with endo-arterial embolization [15]. It is recommended that experienced pelvic surgeons perform cesarean hysterectomy for placenta accreta spectrum [8,16].

The majority of prior studies examining the surgeon's role and outcomes of cesarean hysterectomy for placenta accreta spectrum have focused on gynecologic oncologists [[17], [18], [19], [20]]. In addition, the sample sizes of these past studies were low-to-modest (100–150 cases of cesarean hysterectomy, including 60–70 cases performed by gynecologic oncologists) [18,19]. Studies to assess surgical practice and outcomes among other subspecialities such as maternal-fetal medicine specialists were single center experiences [9,21] and comparison to other surgeon's subspeciality were limited. As there is a wide range of practice variability for placenta accreta spectrum across single centers [22], extrapolating specialty-based outcomes is difficult.

Collectively, there is a scarcity of surgeon subspecialty-type specific data to examine patterns of care and outcomes of cesarean hysterectomy for placenta accreta spectrum. The objective of this study was thus to assess (i) clinical and pregnancy characteristics, (ii) pattern of surgical procedures, and (iii) surgical morbidity associated with cesarean hysterectomy for placenta accreta spectrum based on the subspecialty of the attending surgeon in the United States.