Cost savings and perinatal outcome associated with outpatient management of triplet pregnancy

D. M. Adams*, T. I. Sholl, T. L. Rüssel, Ann B Ragin, R. K. Silver

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To compare the cost and outcome of triplet pregnancies managed with maximal outpatient hedrest versus hospitalized bedrest. STUDY DESIGN: 32 triplet pregnancies managed with outpatient bedrest (4/93-4/96) were compared to an historic cohort of 34 triplets (1/85-3/93) in which routine hospitalization was employed in the third trimester. To estimate and compare cost of patient care between groups, room rates were standardized to current charges, then multiplied by hospitalisation days for mothers and neonates. Selected maternal and neonatal outcomes were also compared between groups. RESULTS: Maternal inpatient days were significantly reduced for the group managed as outpatients. The overall savings in the outpatient group was 11.6%. However, the gestational age at delivery was 1 week greater on average in the hospitalized cohort (33.5 ±2.8 vs 32.5 ±2.8; p = 0.16) and mean birth weight was correspondingly greater in hospitalized cases ( 1942g vs 1718g, p < .005). Neonatal lengths of stay were similar between groups, reflecting a trend toward earlier discharge in the outpatient era of this study. Hospitalization Outpatient (n = 34) (n = 32) p Maternal inpatient days 47.9 ±22.9 21.2 ±14.8 10-7 Maternal costs (S/mother) 31,142 ±14,898 13,792 ±9,590 10-6 Neonatal ISCU days 25.4 ±21.1 26.1 ±18.4 0.84 Neonatal costs <$/infant) 36,655 ±25,818 32,420 ±25,588 0.51 Total family cost ($) 109,966 ±77,453 97,261 ±76,763 0.51 Preeclampsia occurred with greater frequency in the outpatient group (31.3% vs 8.8%; p = .02). and the neonatal complication of intraventricular hemorrhage occurred more commonly in this same cohort (10/96 vs 1/102, P = .004). CONCLUSIONS: 1) Savings attributable to outpatient management were limited. 2) increased maternal and neonatal complications in the outpatient group may have been related to less rigorous bedrest. 3) The observed differences in birth weight, preeclampsia, and intraveniricular hemorrhage deserve prospective evaluation.

Original languageEnglish (US)
JournalActa Diabetologica Latina
Volume176
Issue number1 PART II
StatePublished - Dec 1 1997

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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