Evolución y costes de la prematuridad por indicación médica en un hospital de tercer nivel / Evolution and costs of the medically indicated preterm birth in a tertiary care university hospital

INTRODUCCIÓN Y OBJETIVO: Analizar la evolución y los costes de los partos prematuros iatrogénicos en un hospital universitario de tercer nivel. MÉTODOS: Estudio de cohortes retrospectivo de los partos con edad gestacional comprendida entre 24 y 36+6 semanas en dos periodos temporales: 2001-2005 y 2011-2016. Se identificaron los partos prematuros por indicación médica o iatrogénicos (PPI). Se analizaron variables demográficas y de resultado. Los costes se calcularon mediante el grupo relacionado con el diagnóstico (GRD) de cada ingreso. RESULTADOS: Se obtuvo una muestra de 620 partos prematuros iatrogénicos. La tasa de prematuridad global se mantuvo estable en 9%. La tasa de prematuridad iatrogénica experimentó un incremento relativo del 9,7%. Entre las pacientes con un PPI se apreció un incremento en la edad materna de 27,7 a 32,9 años, de la obesidad (32,2% a 55,5%) y del uso de técnicas de reproducción asistida (6% a 11,1%). Preeclampsia y retraso del crecimiento (CIR) fueron las principales causas de PPI, en los que se incrementó la tasa de cesáreas de 66,9% a 78%, la estancia media de 7,8 días a 9,6 y el coste por paciente de 3.068,6 a 7.331,9 euros. CONCLUSIONES: Se observa un aumento de PPI en el segundo periodo, manteniéndose la prematuridad global. Los cambios demográficos podrían explicar este incremento. Estos cambios están implicados en la fisiopatología de la preeclampsia y el CIR y en el aumento de su incidencia. La prevención primaria y secundaria de esas complicaciones podría reducir la incidencia y los costes de la prematuridad iatrogénica.

INTRODUCTION AND OBJECTIVES: To evaluate the incidence, evolution, causes and costs of premature births (PB) due to medical indication (iatrogenic) in a tertiary care university hospital METHODS: Retrospective cohort study of all deliveries with gestational age between 24 and 36+6 weeks, in two periods 2001-2005 and 2011-2016. Iatrogenic births were identified. Clinical, epidemiological, diagnostic and economic variables were analysed. RESULTS: A sample size of 620 iatrogenic deliveries was obtained. We found a 9.7% relative increase in iatrogenic prematurity rate in the second period as well as an increase in maternal age from 27.7 to 32.9, obesity from 32.2% to 55.5% and the use of assisted reproductive techniques from 6% to 11.1%. Preeclampsia and intrauterine growth restriction were found to be the main causes of iatrogenic premature delivery. In these cases the rates of cesarean section increased from 66.9% to 78%. The average stay per patient and the cost calculated by diagnosis related group (DRG) also showed a statistically significant increase from 7.8 days and 3,068.6 euros to 9.6 days and 7,331.9 euros. CONCLUSIONS: We observed an increase in iatrogenic prematurity in the second period despite the unchanged rate of spontaneous PB. Demographic changes in the population, as well as an increase in obstetric related conditions, seem to be responsible for this increase. Primary and secondary prevention of clinical characteristics may reduce the incidence and costs derived from this type of prematurity.

Economic consequences of over-diagnosis of threatened preterm labor.

OBJECTIVE: To investigate whether adherence to a cervical length-based protocol can reduce both unnecessary admissions and the socioeconomic costs associated with inappropriately admitted patients. METHODS: The present retrospective observational study included women admitted for threatened preterm labor (TPL) at 24-34 weeks of pregnancy to a tertiary hospital in the Canary Islands, 2009-2014. Data were reviewed from all patients admitted for TPL. Those with a long cervix (>25 mm) were classified as "inappropriate admissions", and both the economic burden based on diagnosis-related group (DRG) and the social costs associated with sick leave for these women were calculated. RESULTS: During the 6-year study period, 430 women were admitted for TPL. The rate of inappropriate hospital admissions was 45% in the first year, but was reduced to 23% in the final year (P<0.001); the premature delivery rates in these years did not differ (P=0.224). The mean DRG-based cost of the admission per patient with a long cervix was EU euros €2099. The total annual costs from inappropriate admission (both social security sick leave costs and hospital costs) were estimated to be up to €571 047.37 during the 6-year study period, and reduced from €60 420.76 in 2009 to €29 998.04 in 2014. CONCLUSION: Reductions in inappropriate admissions from applying cervical length-based management protocol could reduce healthcare costs without increasing the incidence of premature delivery.