Help a mother out: The impact of acute care surgeon response in postpartum hemorrhage

Janet S Lee; Gregory Day; Daniel Valentino; Caroline Hedges; Cassie Decker; Jessica Booth; Renee Lockey; Thomas J Schroeppel

doi:10.1016/j.amjsurg.2023.07.032

Help a mother out: The impact of acute care surgeon response in postpartum hemorrhage

Am J Surg. 2023 Dec;226(6):882-885. doi: 10.1016/j.amjsurg.2023.07.032. Epub 2023 Jul 27.

Authors

Janet S Lee¹, Gregory Day², Daniel Valentino³, Caroline Hedges⁴, Cassie Decker⁵, Jessica Booth⁶, Renee Lockey⁷, Thomas J Schroeppel⁸

Affiliations

¹ Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA; Department of Surgery, University of Colorado, Aurora, CO, USA. Electronic address: janet.lee@cuanschutz.edu.
² Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA. Electronic address: Gregory.day@uchealth.org.
³ Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA. Electronic address: Daniel.valentino@uchealth.org.
⁴ Department of Obstetrics and Gynecology, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA. Electronic address: cahedges@gmail.com.
⁵ Department of Trauma Research, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA. Electronic address: Cassandra.decker@uchealth.org.
⁶ Department of Anesthesiology, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA. Electronic address: Jessica.booth@uchealth.org.
⁷ Department of Obstetrics and Gynecology, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA. Electronic address: Renee.lockey@uchealth.org.
⁸ Department of Trauma and Acute Care Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA. Electronic address: Thomas.schroeppel@uchealth.org.

PMID: 37532591
DOI: 10.1016/j.amjsurg.2023.07.032

Abstract

Introduction: A Code White (CW) activation is a hospital-wide alert for postpartum hemorrhage (PPH) and acute care surgeons (ACS) were added to the response team to assist in resuscitation. A multidisciplinary training program was also implemented. This study aimed to evaluate the impact of ACS involvement and training on maternal outcomes.

Methods: A retrospective review was performed on all CW activations from 1/1/2015-8/31/2022. Three groups-pre-ACS response, ACS response, and ACS response + training (R&T)-were compared.

Results: 218 patients had CW activations. ACS response increased MTP activations (50.0%vs76.5%vs76.2%, p = 0.014) and TXA administration (50.0%vs96.5%vs93.3%, p < 0.0001). The ACS R&T had the highest ACS presence (53.6%vs72.9%vs96.2%, p < 0.0001), shortest operation (99 vs 67 vs 53min, p = 0.002), lowest crystalloid use (2000 vs 1110 vs 800 ml, p = 0.003), and lowest transfusion requirements. Mortality decreased from 17.9% in pre-ACS to 2.4% in ACS response and 0% in ACS R&T (p < 0.0001).

Conclusion: ACS assistance in CW activations and multidisciplinary PPH education led to the prevention of maternal mortality. ACS are a valuable resource in this unique population.

MeSH terms

Blood Transfusion
Female
Humans
Mothers
Postpartum Hemorrhage* / prevention & control
Pregnancy
Retrospective Studies
Surgeons*