Friedman Alexander M, Ananth Cande V, Chen Ling, D'Alton Mary E, Wright Jason D
a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and.
b Department of Epidemiology , Joseph L. Mailman School of Public Health, Columbia University , New York , NY , USA.
J Matern Fetal Neonatal Med. 2016;29(7):1030-5. doi: 10.3109/14767058.2015.1035250. Epub 2015 Apr 13.
Given that cesarean delivery is one of the most commonly performed surgical procedures in the United States and an important contributor to obstetric care costs, this analysis sought to examine maternal hospital costs associated with trial of labor after cesarean delivery (TOLAC) versus repeat cesarean delivery (RCD).
A national sample was used to identify women with singleton pregnancy who underwent either TOLAC or RCD from 2006 to 2012. Women with diagnoses that could confound cost via extended hospital length of stay prior to delivery were excluded. Other medical and obstetric covariates that could influence cost were included in an adjusted model.
A total of 485,247 women were identified, including 365,596 (75.3%) cesarean deliveries without labor, 41,988 (8.6%) successful and 77,663 (16.0%) unsuccessful TOLAC deliveries. The inflation-adjusted median costs in this cohort were $5512 for cesarean without labor, $4175 for successful TOLAC, $5166 for all TOLAC attempts, and $5759 for failed TOLAC. In a multivariable model, hospital region was a major predictor of median cost as were demographic variables and medical comorbidities.
TOLAC is associated with modest reductions of cost for maternal hospitalizations. However, other medical, demographic and hospital factors appear to be more important factors.
鉴于剖宫产是美国最常见的外科手术之一，也是产科护理费用的重要组成部分，本分析旨在研究剖宫产术后试产（TOLAC）与再次剖宫产（RCD）相关的产妇住院费用。
使用全国样本确定2006年至2012年期间接受TOLAC或RCD的单胎妊娠妇女。排除那些因分娩前住院时间延长而可能混淆费用的诊断患者。在调整模型中纳入了其他可能影响费用的医学和产科协变量。
共确定了485,247名妇女，包括365,596例（75.3%）未试产的剖宫产、41,988例（8.6%）成功的TOLAC分娩和77,663例（16.0%）失败的TOLAC分娩。该队列中经通胀调整后的中位数费用分别为：未试产剖宫产5512美元、成功的TOLAC分娩4175美元、所有TOLAC尝试5166美元、失败的TOLAC分娩5759美元。在多变量模型中，医院所在地区、人口统计学变量和医学合并症是中位数费用的主要预测因素。
TOLAC与产妇住院费用适度降低相关。然而，其他医学、人口统计学和医院因素似乎是更重要的因素。
