OBJECTIVE: To evaluate how the COVID-19 pandemic may have negatively impacted birth outcomes in patients who tested negative for the SARS-CoV-2 virus. STUDY DESIGN: We conducted a retrospective cohort study using electronic health records of pregnant women admitted to a tertiary medical center in New York City, an epicenter of the pandemic. Women with a singleton gestation admitted for delivery from March 27-May 31, 2019 and March 27-May 31, 2020 were included. Women less than 18 years old, those with a positive SARS-CoV-2 PCR test on admission, fetal anomaly, or multiple gestation were excluded. Adverse pregnancy outcomes were compared between groups. Univariable and multivariable logistic regression was used to assess outcomes. The primary outcome was preterm birth. RESULTS: Women who delivered during the 2020 study interval had a significantly higher rate of hypertensive disorders of pregnancy (gestational hypertension or preeclampsia) (OR 1.40, 95% CI 1.05-1.85; p=0.02), postpartum hemorrhage (PPH) (OR 1.77, 95% CI 1.14-2.73; p=0.01), and preterm birth (OR 1.49, 95% CI 1.10-2.02; p=0.01). Gestational age at delivery was significantly lower in the 2020 cohort compared to the 2019 cohort (39.3 vs. 39.4 weeks, p=0.03). After adjusting for confounding variables, multivariate analysis confirmed a persistent increase in hypertensive disorders of pregnancy (OR=1.56, 95% CI 1.10-2.20, p=0.01), postpartum hemorrhage (OR=1.74, 95% CI: 1.06-2.86, p=0.03), and preterm birth (OR=1.72, 95% CI: 1.20-2.47, p=0.003) in patients who delivered in 2020 compared to the same period in 2019. Specifically, medically indicated preterm births increased during the pandemic (OR=3.17, 95% CI: 1.77-5.67, p<0.0001). CONCLUSION: Those who delivered during the COVID-19 pandemic study interval were more likely to experience hypertensive disorders of pregnancy, medically indicated preterm birth, and postpartum hemorrhage even in the absence of SARS-CoV2 infection.
Objective: To mitigate transmission of SARS-CoV-2 infection and decrease exposure to the hospital setting, Mount Sinai Hospital implemented new protocols, including early postpartum discharge. Early discharge would allow for more single-bedded rooms, limiting exposure to other patients and their support persons. During the pandemic, patients were discharged to home on postpartum days one or two after vaginal or cesarean delivery, respectively, instead of day two or three, unless longer hospitalization was needed for medical indications. We aim to determine if the readmission rate was increased in the setting of earlier discharge during the COVID-19 pandemic. Study Design: Historical cohort study comparing the readmission rate in SARS-CoV-2 negative women who presented to Mount Sinai Hospital for delivery admission from March-May 2019 versus March-May 2020. The primary outcome was readmission rate within six weeks of discharge day. Maternal and neonatal characteristics and outcomes were compared between groups using T-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher’s exact tests for categorical measures, as appropriate. Primary and secondary outcomes were assessed using linear and logistic univariable and multivariable regression. Results: Patients in the 2020 cohort (n=1,078) were significantly less likely to have public/state insurance (p=0.02), more likely to have pre-gestational diabetes (p=0.02), gestational diabetes (p=0.04), gestational hypertension (p<0.01) and an operative vaginal or cesarean delivery (vs. spontaneous vaginal delivery, p=0.01) compared to 2019 cohort patients (n=1,910). Patients in the 2020 cohort were significantly more likely to have an earlier postpartum day of discharge and a shorter median length of stay compared to 2019 cohort patients (both p<0.01). Despite differences in length of stay, the rate of readmission was similar between the two groups (p=0.45). Conclusion: During the COVID-19 pandemic, there was no difference in readmission rate despite shorter hospital stays.
Introduction: With the aging U.S. population, peripheral vascular procedures will become increasingly common. The objective of this study is to characterize the factors associated with increased total costs after peripheral bypass surgery. Methods: Data for 34,819 patients undergoing peripheral bypass surgery in NY State were extracted using the Statewide Planning and Research Cooperative System (SPARCS) database for years 2009-2017. Patient demographics, All Patient Refined Diagnostic Related Groups (APR) severity score, mortality risk, hospital volume, and length of stay data were collected. Primary outcomes were total costs and length of stay. Data were analyzed using univariate and multivariate analysis. Results: 28.1% of peripheral bypass surgeries were performed in New York City. 7.9% of patients had extreme APR severity of illness whereas 32.0% had major APR severity of illness. 6.3% of patients had extreme risk of mortality and 1 in every 5 patients (20%) had major risk of mortality. 24.9% of patients were discharged to a facility. The mean length of stay (LOS) was 9.9 days. Patient LOS of 6-11 days was associated with +$2,791.76 total costs. Mean LOS of ≥ 12 days was associated with + $27,194.88 total costs. Multivariate analysis revealed risk factors associated with an admission listed in the fourth quartile of total costs (≥$36,694.44) for peripheral bypass surgery included NYC location (2.82, CI 2.62-3.04), emergency surgery (1.12, CI 1.03-1.22), extreme APR 2.08, 1.78-2.43, extreme risk of mortality (2.73, 2.34-3.19), emergency room visit (1.68, 1.57-1.81), discharge to a facility (1.27, CI 1.15-1.41), and LOS in the third or fourth quartile (11.09, 9.87-12.46). Conclusion: The cost of peripheral bypass surgery in New York State is influenced by a variety of factors including LOS, patient comorbidity and disease severity, an ER admission, and discharge to a facility.
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