{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T06:54:10Z","timestamp":1782975250007,"version":"3.54.5"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate trends in hysterectomy case volume for placenta accreta spectrum (PAS) disorder over time and compare maternal outcomes between high\u2010 and low\u2010volume centers. Specifically, we examined whether surgical volume influences severe maternal morbidity (SMM) and other key perioperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population\u2010based retrospective cohort study of patients aged 18\u201350\u2009years who underwent hysterectomy for PAS in Ontario, Canada, from January 1, 2003, to January 1, 2022. Cases were identified using provincial administrative health databases. High\u2010volume centers were defined as institutions performing \u22659 PAS hysterectomies annually, based on probability modeling and receiver operating characteristic analysis. The primary outcome was a validated composite measure of SMM, including massive transfusion, intensive care unit (ICU) admission, surgical complications, readmission, and length of hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 778 patients, 151 were treated at high\u2010volume centers. These patients experienced significantly lower rates of SMM compared to those treated at low\u2010volume centers (45.0% vs. 71.7%; adjusted relative risk [aRR] 0.59, 95% confidence interval [CI]: 0.49\u20130.72). Risks of massive transfusion (aRR 0.57, 95% CI: 0.47\u20130.70) and ICU admission (aRR 0.30, 95% CI: 0.15\u20130.58) were also markedly reduced. Length of hospital stay was shorter at high\u2010volume centers (1.88 vs. 3.90\u2009days;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Each additional PAS hysterectomy performed in the prior year at a given institution was associated with a 3% reduction in SMM risk (aRR 0.97, 95% CI: 0.96\u20130.98).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High\u2010volume centers demonstrate significantly better maternal outcomes for PAS hysterectomy. These findings support centralizing PAS care to improve patient safety and surgical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70846","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T12:12:56Z","timestamp":1770207176000},"page":"382-390","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hysterectomy for placenta accreta spectrum disorder: Impact of institutional surgical volume on patient outcomes"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9859-2654","authenticated-orcid":false,"given":"Lacey C.","family":"Brennan","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Peter Lougheed Center  Calgary Alberta Canada"},{"name":"Department of Obstetrics and Gynecology University of Calgary  Calgary Alberta Canada"},{"name":"Department of Obstetrics and Gynecology Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Bougie","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Shellenberger","sequence":"additional","affiliation":[{"name":"Institute of Clinical Evaluative Sciences (ICES)  Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Pudwell","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Queen's University, Kingston Health Sciences Center Kingston General Hospital  Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kingdom","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Thiel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Royal University Hospital, University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian 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