Variation in Inpatient Admission for Management and Cost Drivers in Placenta Accreta Spectrum Disorder

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Health Economics

Background:

• Placenta accreta spectrum (PAS) is a high-risk pregnancy complication.
• Management strategies for PAS can vary significantly, impacting patient outcomes and healthcare costs.

Purpose of the Study:

• To evaluate the variability in inpatient antepartum management of PAS.
• To determine the association between different management strategies and hospitalization costs.

Main Methods:

• Retrospective cohort study using the 2016-2021 Nationwide Readmissions Database.
• Identified patients (15-54 years) undergoing cesarean hysterectomy for PAS (23-35 weeks gestation).
• Categorized patients into four management groups based on antepartum hospitalization and predelivery length of stay (LOS).

Main Results:

• Median total hospitalization costs ranged from $21,829 to $51,039 across management groups.
• Management variation was linked to a 3- to 29-fold higher likelihood of high total hospitalization costs.
• Disseminated intravascular coagulation was the only clinical factor associated with a significant cost increase ($12,921).

Conclusions:

• Nearly 20% of PAS patients had an all-cause antepartum hospitalization.
• Variations in inpatient PAS management are a significant driver of hospitalization costs.
• Reducing unnecessary management variations could lead to substantial cost savings.