Division of Maternal and Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Maternal and Fetal Medicine, Duke University Medical Center, Durham, North Carolina.
Am J Perinatol. 2019 Mar;36(4):399-405. doi: 10.1055/s-0038-1668591. Epub 2018 Aug 21.
To assess the costs, complication rates, and harm-benefit tradeoffs of induction of labor (IOL) compared to scheduled cesarean delivery (CD) in women with class III obesity.
We conducted a cost analysis of IOL versus scheduled CD in nulliparous morbidly obese women. Primary outcomes were surgical site infection (SSI), chorioamnionitis, venous thromboembolism, blood transfusion, and readmission. Model outcomes were mean cost of each strategy, cost per complication avoided, and complication tradeoffs. We assessed the costs, complication rates, and harm-benefit tradeoffs of IOL compared with scheduled CD in women with class III obesity.
A total of 110 patients underwent scheduled CD and 114 underwent IOL, of whom 61 (54%) delivered via cesarean. The group delivering vaginally experienced fewer complications. SSI occurred in 0% in the vaginal delivery group, 13% following scheduled cesarean, and 16% following induction then cesarean. In the decision model, the mean cost of induction was $13,349 compared with $14,575 for scheduled CD. Scheduled CD costs $9,699 per case of chorioamnionitis avoided, resulted in 18 cases of chorioamnionitis avoided per additional SSI and 3 cases of chorioamnionitis avoided per additional hospital readmission. In sensitivity analysis, IOL is cost saving compared with scheduled CD unless the cesarean rate following induction exceeds 70%.
In morbidly obese women, induction of labor remains cost-saving until the rate of cesarean following induction exceeds 70%.
评估与计划性剖宫产相比，肥胖程度为 III 级的妇女行引产（IOL）的成本、并发症发生率和利弊权衡。
我们对初产妇病态肥胖妇女行 IOL 与计划性 CD 的成本进行了分析。主要结局为手术部位感染（SSI）、绒毛膜羊膜炎、静脉血栓栓塞、输血和再入院。模型结局为每种策略的平均成本、每避免一种并发症的成本以及并发症的权衡。我们评估了肥胖程度为 III 级的妇女行 IOL 与计划性 CD 的成本、并发症发生率和利弊权衡。
共有 110 名患者行计划性 CD，114 名患者行 IOL，其中 61 名（54%）行剖宫产分娩。阴道分娩组并发症较少。SSI 在阴道分娩组中发生率为 0%，计划性剖宫产组为 13%，引产加剖宫产组为 16%。在决策模型中，引产的平均成本为 13349 美元，而计划性 CD 的成本为 14575 美元。每避免 1 例绒毛膜羊膜炎的成本为 9699 美元，每增加 1 例 SSI 可避免 18 例绒毛膜羊膜炎，每增加 1 例再入院可避免 3 例绒毛膜羊膜炎。在敏感性分析中，除非引产加剖宫产的剖宫产率超过 70%，否则 IOL 与计划性 CD 相比具有成本效益。
在病态肥胖妇女中，与计划性 CD 相比，IOL 一直具有成本效益，除非引产加剖宫产的剖宫产率超过 70%。
