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Analysis of Maternal Complications during Labor and Delivery Using Cost-based Criticality.
Abstract Number: T-30
Abstract Type: Original Research
The incidence of severe maternal morbidity during childbirth has more than doubled in the last 2 decades in the United States.(1) Ranking complications based on criticality may help prioritize interventions and reduce severe maternal morbidity.(2) Criticality is the product of the incidence and severity of a complication. Severity can be estimated with the adjusted excess cost attributed to this complication.(3) The aim of this study was to calculate and rank the cost-based criticality of maternal complications during labor and delivery in a national representative sample.
Discharge records indicating labor and delivery, and 17 maternal complications were identified with ICD-9-CM codes in the National Inpatient Sample (NIS) 2012, a 20% representative sample of discharges records from community hospitals in the United States. The adjusted excess cost was calculated as the difference between the mean adjusted costs of discharges with and without the examined complication.(3) Costs were calculated as the product of hospital charges and a cost-to-charge ratio provided by the NIS, and adjusted with a linear regression model. Confidence intervals (CI) were exact CI or bootstrap CI.
The study sample included 734,865 delivery-related discharges corresponding to 19 % of the live births reported in the United States in 2012. Maternal death was recorded in 29 discharges (0.39 per 10,000; 95% CI: 0.26-0.57) and at least 1 complication in 80,865 (11.0 per 100; 95% CI: 10.9-11.1). The 4 most critical complications were: preeclampsia and eclampsia (criticality: $93.3), postpartum hemorrhage ($47.2), isolated hypertension of pregnancy ($34.2), and anesthesia-related complications ($5.8) (Table 1).
Using a cost-based approach, we identify anesthesia-related complications as a significant maternal safety concern, ranking 4th in criticality among the 17 complications examined. Further investigation is warranted to develop effective interventions to reduce obstetric anesthesia-related complications. Our results also validate the choice of 2 out of the 3 Patient Safety Bundles launched by the National Partnership for Maternal Safety, obstetric hemorrhage and severe hypertension in pregnancy.(4)
(1) Obstet Gynecol 2012;120:1029-36
(2) Joint Commission Resources 2010
(3) Anesth Analg 2016;122: 2007-16
(4) Obstet Gynecol 2014;123: 973-7