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Poster Session 2

(628) Accuracy of placenta accreta spectrum administrative coding and outcomes inside and outside of referral centers.

Thursday, January 30, 2025
4:00 PM – 6:00 PM  
Objective: Since 2015, ICD-10 codes for placenta accreta spectrum (PAS) have been used for research for this life-threatening pregnancy condition. However, this set of diagnostic codes have yet to be validated thoroughly and previous analyses suggest morbidity may be worse in referral centers. We sought to examine the accuracy of PAS ICD-10 codes in and outside of PAS referral centers and to characterize the associated outcomes.

Study Design: We conducted a case series of all ICD-10 diagnostic codes for PAS at two PAS referral centers within two health systems compromised of 17 delivery hospitals, representing the majority of deliveries in our state between September 2015 and December 2023. We performed ICD-10 code validation to assess accuracy of codes and stratified results based on true and false positives. True positive codes were those cases with histopathologic evidence of PAS or FIGO clinical criteria for PAS in the absence of histopathology. We compared composite maternal morbidity with logistic regression adjusted for delivery characteristics (maternal age, prior caesarean, and gestational age) overall, stratified by PAS center.

Results: Of 394 deliveries with a PAS diagnostic code, 68% occurred at a PAS referral center. False positive rate of PAS diagnosis was significantly higher at non-referral centers compared to referral centers (74% vs 24%, p< 0.001). All cases of PAS3/Percreta and nearly all cases of PAS2/Increta were managed at referral centers (Table). There was a higher odds of composite maternal morbidity at PAS centres compared to non-referral centres (aOR 2.57; 95% CI 1.42-4.68), but when excluding false positive cases, this association was not seen (aOR 1.55; 95%CI 0.65-3.69, Figure). Absence of PAS3/Percreta at non-referral centers precluded analysis of morbidity by severity. 

Conclusion:

In contrast to referral centers, the PAS ICD-10 code is most often inaccurate at non-referral centres with three-quarters being misdiagnosed. Among true positive PAS cases, despite a higher PAS severity at referral centers, maternal morbidity was not increased.