Isayama Tetsuya, O'Reilly Daria, Beyene Joseph, Shah Prakesh S, Lee Shoo K, McDonald Sarah D
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Newborn and Developmental Pediatrics, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
J Pediatr. 2020 Nov;226:96-105.e7. doi: 10.1016/j.jpeds.2020.06.060. Epub 2020 Jun 28.
To assess the hospital care cost and resource use associated with discharge timings after late preterm and term births.
This population-based cohort study and cost analysis included all healthy singleton late preterm (35-36 weeks gestational age) and term infants (37-41 weeks gestational age) born vaginally in hospitals in Ontario, Canada, from 2003 to 2012. Early, late, and very late discharge (<48, 48-71, and 72-95 hours after birth, respectively) were compared using generalized linear models. The primary outcome was the total hospital care cost (hospitalizations and emergency department visits) per infant within 28 days of birth.
Among 860 693 singletons (3.7% late preterm), early discharge increased significantly over 10 years for term infants (from 69% to 82%; P < .001), but not late preterm infants (from 32% to 35%; P = .75). The mean total cost within 28 days after birth was not significantly different for late preterm infants between early discharge and late discharge after adjustment. However, for term infants, the adjusted cost was higher with early discharge than late discharge (aMCD $311 [95% CI, $211-$412] per infant; $366 [95% CI, $355-$377] per mother-infant dyad). The neonatal readmission rates were higher after early than late discharge for late preterm and term infants.
Early discharge was not associated with cost savings for vaginally born healthy singleton late preterm infants, and instead was associated with a cost increase for term infants. Early discharge was associated with higher neonatal readmission rates. Individualized approach balancing the risk and benefit is appropriate to determine the discharge timings.
评估晚期早产和足月分娩后出院时间所关联的医院护理成本及资源利用情况。
这项基于人群的队列研究及成本分析纳入了2003年至2012年在加拿大安大略省医院经阴道分娩的所有健康单胎晚期早产（胎龄35 - 36周）和足月婴儿（胎龄37 - 41周）。使用广义线性模型对早期、晚期和极晚期出院（分别为出生后<48小时、48 - 71小时和72 - 95小时）进行比较。主要结局是出生后28天内每名婴儿的总医院护理成本（住院和急诊就诊）。
在860693名单胎婴儿中（3.7%为晚期早产），足月婴儿早期出院在10年期间显著增加（从69%增至82%；P <.001），但晚期早产婴儿未出现这种情况（从32%增至35%；P =.75）。调整后，晚期早产婴儿早期出院和晚期出院后出生后28天内的平均总成本无显著差异。然而，对于足月婴儿，调整后的成本早期出院高于晚期出院（每名婴儿调整后平均成本差异为311加元[95%CI，211 - 412加元]；每对母婴为366加元[95%CI，355 - 377加元]）。晚期早产和足月婴儿早期出院后的新生儿再入院率高于晚期出院。
对于经阴道分娩的健康单胎晚期早产婴儿，早期出院与成本节约无关，反而与足月婴儿成本增加有关。早期出院与较高的新生儿再入院率相关。采用平衡风险和收益的个体化方法来确定出院时间是合适的。
