Introduction
In 2008, childbirth continued to be the most common reason for hospitalization in U.S. hospitals1—despite declining to 4.2 million total stays from a high of 4.5 million in 2007. Most of these (67 percent) were delivered vaginally, and the majority of vaginal deliveries (57 percent) occurred without complications or serious procedures.
Over the last several years, there has been a dramatic shift in the utilization of certain obstetric procedures. These changes in the use of certain childbirth-related procedures have garnered media attention and stimulated interest in research on the safety, clinical outcomes, and economic implications of shifts in mode of delivery and utilization of obstetric procedures. Cesarean sections (C-sections) have grown from 21 percent of childbirths in 1997 to 33 percent in 2008.2 While some studies have highlighted the maternal benefits of elective C-sections,3 other research indicates that C-sections generally tend to be more costly than vaginal deliveries,4 are associated with higher rates of maternal rehospitalization and postpartum medical care utilization.5,6 Some research indicates potentially worse neonatal outcomes for C-section deliveries, including elevated risk of mortality.7 During this time, vaginal births after C-section (VBAC), which are associated with rare but serious complications including uterine scar rupture,8 have declined and further contributed to the growing number of repeat C-sections performed. More recent reviews contend that VBAC is a reasonable and safe choice for the majority of women with a prior C-section.9 Additionally, national clinical groups, such as the American College of Obstetrics and Gynecology (ACOG),10 have recommended against the routine use of episiotomies to assist vaginal births.
In light of the importance of childbirth-related hospitalizations in the health care system, it is important to quantify and understand changing trends in hospital procedures for childbirth. This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on childbirths occurring in U.S. community hospitals in 2008. All data are reported from the maternal perspective (i.e., reflecting the experience of the mother, not the newborn). Variations in the utilization and costs associated with childbirth-related hospitalizations are illustrated with a focused look at differences across mode of delivery and payer type. All differences between estimates noted in the text are statistically significant at the 0.05 level or better. Highlights
In 2008, there were 4.2 million maternal childbirth-related hospitalizations (down from 4.5 million in 2007) totaling $18.9 billion in hospital costs.
More than half of all maternal childbirth-related hospital stays were billed to private insurance (2.2 million), while 40 percent were billed to Medicaid (1.7 million).
In 2008, 33 percent of childbirths were by C-section, up from 21 percent in 1997. In fact, C-sections were, overall, the most commonly performed operating room procedures in U.S. hospitals.
The increase in repeat C-section delivery was coupled with a decrease in the rate of VBACs, which fell to 1 percent of all deliveries in 2008.
C-sections accounted for 34 percent of all privately insured births, but only 28 percent of uninsured births.
Reflecting changing practice patterns, there was also a 32 percent decrease in the use of forceps and a 60 percent decrease in episiotomies.
Findings
In 2008, women experienced 4.2 million childbirths in U.S. community hospitals, a decrease from the 4.5 million childbirths in 2007. Still, childbirth remained the most common reason for hospitalization; these stays accounted for 11 percent of all hospital stays. Childbirth-related hospitalizations totaled $18.9 billion in hospital costs, 5 percent of all inpatient hospital costs.
Characteristics of childbirth-related hospitalizations by mode of delivery
Table 1 presents utilization, length of stay (LOS), and cost information for maternal hospitalizations associated with the delivery of infants in U.S. community hospitals by type of delivery. Across all types of delivery, the mean LOS was 2.6 days—it ranged considerably from 2.1 days for vaginal deliveries without complications to 4.5 days for C-sections with complications.
full-text:
Statistical Brief #110
.png)
No hay comentarios:
Publicar un comentario