The Soleymani and Collins Obstetric Morbidity Score (SaCOMS): a
quantitative tool for measuring maternal morbidity from complex
obstetric surgery such as placenta accreta spectrum (PAS)
Abstract
Objective: To describe a suggested version of the Clavien-Dindo
morbidity classification specific to obstetrics and employ it to build a
cumulative morbidity score which fully reflects the ‘patient
experience’. To demonstrate the utility of this novel system in a cohort
of women with Placenta Accreta Spectrum (PAS). Design: Delphi
consensus and retrospective application of the resulting scores to
morbidity from PAS surgery. Setting: UK Tertiary referral
centre for PAS. Population: Women who had caesarean
hysterectomy for PAS. Methods: The Clavien-Dindo
classification was modified to reflect obstetric procedures and a
quantitative morbidity measure, the Soleymani and Collins Obstetric
Morbidity Score (SaCOMS), was developed based on this. Both were then
validated using a Delphi consensus of experts in PAS and retrospectively
applied to a cohort of 54 women with PAS. Main Outcome
measures: Delphi consensus of >80%, binary outcome of
adverse event or not and quantitative values from the SaCOMS.
Results: Clinicians with expertise in PAS believe that the
Modified Obstetric Clavien-Dindo classification system and the novel
SaCOMS tool can improve assessment of maternal morbidity, and better
reflect the ‘patient experience’. Application to the PAS cohort
demonstrates that surgery by gynae-oncological surgeons may be
associated with decreased incidence and cumulative morbidity outcomes
for women with PAS, especially those with the most severe presentation.
Conclusions: This study presents a clinically useful
obstetric-specific classification system for surgical morbidity. SaCOMS
also provides a quantitative reflection of the full patient- journey
experienced as a result of surgical complications enabling a more
patient-centred representation of morbidity.