Poster Session 1
Eve Overton, MD (she/her/hers)
Assistant Professor
Columbia University Medical Center
New York, NY, United States
Gabriela F. Tessler, MD
Resident
Columbia University Medical Center
New York, NY, United States
Brittany Arditi, MD, MSCR
Clinical Fellow
Columbia University Irving Medical Center
New York, NY, United States
Maria Andrikopoulou, MD
Assistant Professor
Columbia University Irving Medical Center
New York, New York, United States
Alexandre Buckley de Meritens, MD
Columbia University Irving Medical Center
New York, New York, United States
Kartik K. Venkatesh, MD, PhD (he/him/his)
Associate Professor
The Ohio State University
Columbus, Ohio, United States
Alexander M. Friedman, MD, MPH
Professor of Obstetrics and Gynecology
Columbia University Irving Medical Center
New York, New York, United States
Mirella Mourad, MD
Assistant Professor
Columbia University Medical Center
New York, New York, United States
Timothy Wen, MD, MPH (he/him/his)
Assistant Professor
University of California, San Diego
Irvine, California, United States
Management of placenta accreta spectrum (PAS ) frequently includes prolonged hospitalization and antepartum inpatient care, but cost estimates are limited. We evaluated costs for inpatient care associated with cesarean hysterectomies for PAS and patient factors associated with increased cost.
Study Design:
A serial cross-sectional analysis of cesarean hysterectomies for PAS occurring between 23-35 weeks were identified in the 2016-2021 Nationwide Readmission Database stratified by antepartum inpatient care in three groups. Cesarean hysterectomies were categorized by those with no antepartum admission and with < 2 day pre-delivery length of stay (LOS) (Group 1); those with prolonged pre-delivery LOS ( >2 days) (Group 2); and those distinct antepartum admission of any length prior to delivery (Group 3). Total inpatient costs for each group were assessed. The primary outcome was high cost, defined as >80th percentile of inpatient costs in this cohort, and secondarily, total inpatient costs as a continuous measure adjusted for inflation to represent 2023 US dollars. Adjusted logistic and linear regression models assessed the association between groups with the primary and secondary outcomes, adjusting for clinical, demographic, and hospital factors.
Results:
From 2016-2021, 3,309 cesarean hysterectomies for PAS were identified with 1,684 (50.9%), 1,065 (32.2%), and 560 (16.9%) in Groups 1, 2, and 3 respectively. High costs (≥$49,706) were noted in 9.3%, 39.6%, and 28.0% of deliveries in Groups 1, 2, and 3, respectively. In adjusted analyses, Group 2 had the highest mean costs (Figure 1, p< 0.05). Groups 2 (aOR 9.33, 95% CI: 6.45, 13.50) and 3 (aOR 5.18, 95% CI: 3.48, 7.71) had higher likelihood of high costs, and on average had $23,477 and $17,204 higher costs versus Group 1 (Figure 2). Disseminated intravascular coagulopathy, placenta increta/percreta, and postoperative LOS was on average associated with $12,940, $6,500, $3,941 (per day) higher costs (p< 0.01).
Conclusion:
In the US between 2016 to 2021, prolonged pre-delivery hospitalization for PAS was associated with increased cost of care.
