Severe Maternal Morbidity and Hospital Cost among Hospitalized Deliveries in the United States

Chen, Han-Yang; Chauhan, Suneet P.

doi:10.1055/s-0038-1649481

Cited by 24 publications

(15 citation statements)

References 29 publications

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“…7,12 However, previous studies of SMM in the US have primarily focused on severe complications during the delivery hospitalization because of limitations in available data. 5,6,[13][14][15] A few exceptions are noted in studies by Callaghan et al, 6 Harvey et al, 16 and Girsen et al 17 Nonetheless, little is known about the rate and pattern of de novo postpartum SMM because these studies did not explicitly examine such cases. Similar to pregnancy-associated mortality, the distribution and characteristics of SMM that is first diagnosed during the delivery hospitalization may differ from those of SMM that first occurs after delivery discharge.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US

et al. 2021

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Key Points Question What proportion of de novo severe maternal morbidity is diagnosed after delivery discharge, and what are the most common factors and maternal characteristics associated with severe maternal morbidity among women in the US? Findings In this cohort study of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014, 14% and 16% of severe maternal morbidity among those with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after delivery discharge. The most common factors and maternal characteristics associated with severe maternal morbidity after delivery were different than those identified at delivery. Meaning The study’s findings suggest that expanding the focus of severe maternal morbidity assessment to the postdelivery discharge period could improve understanding of severe maternal morbidity and may create opportunities to improve maternity care.

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Section: Introductionmentioning

confidence: 99%

Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US

et al. 2021

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“…Severe maternal morbidity (SMM), or unexpected life-threatening complications during delivery hospitalization, carries significant health and economic consequences. 1,2 Over the past few decades, the US SMM rate has steadily increased through at least 2014. 3,4 While the reasons for this rise are not fully known, the increasing prevalence of chronic conditions and other health risks among women prior to and during pregnancy (eg, hypertension, diabetes, and obesity) are likely contributors.…”

Section: Introductionmentioning

confidence: 99%

Trends in Severe Maternal Morbidity in the US Across the Transition to ICD-10-CM/PCS From 2012-2019

et al. 2022

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Key Points Question How did US rates of severe maternal morbidity (SMM), overall and by SMM indicator and state, change from 2012 to 2019 across the transition to International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System ( ICD-10-CM/PCS ) coding? Findings In this repeated cross-sectional analysis including 5.9 million delivery hospitalizations from 2012 to 2019, the national estimated rate of SMM (excluding blood transfusions) increased from 69.5 to 79.7 per 10 000 delivery hospitalizations, which was not associated with the ICD-10-CM/PCS transition. However, changes over time varied by indicator and state and some data may not be comparable across coding systems. Meaning Overall SMM rates increased between 2012 and 2019, with noted variation by indicator and state.

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“…In contrast, the NIS and NYC studies analyzed mixed populations of commercially insured and Medicaid patients (the former 50% Commercial and 44% Medicaid patients and the latter 38% Commercial and 58% Medicaid patients). 14 , 15 In addition, the earlier studies used an algorithm for identifying SMM based on ICD-9 codes, whereas the present study was based on ICD-10 codes. 14–16 …”

Section: Discussionmentioning

confidence: 98%

“…Two earlier studies reported delivery hospitalization costs associated with SMM, using, respectively, discharge data from the 2011 National Inpatient Sample (NIS) and a dataset of all delivery hospitalizations in New York City (NYC) from 2008 to 2012. 14 , 15 Direct comparison of these delivery cost estimates with estimates based on reimbursements in separate Commercial and Medicaid populations is difficult, given the different population structures and cost data sources. The earlier analyses estimated the costs expended by the hospital but excluded physician expenses.…”

Section: Discussionmentioning

confidence: 99%

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Costs of Severe Maternal Morbidity in U.S. Commercially Insured and Medicaid Populations: An Updated Analysis

Black

Vesco

Mehta

et al. 2021

Women's Health Reports

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Background: The most common reason for hospitalization in the United States is childbirth. The costs of childbirth are substantial. Materials and Methods: This was a retrospective cohort study of hospital deliveries identified in the MarketScan ® Commercial and Medicaid health insurance claim databases. Women with an inpatient birth in the calendar year 2016 were included. Severe maternal morbidity (SMM) was identified using the Centers for Disease Control and Prevention algorithm of 21 International Classification of Diseases-10 codes. Mean costs and cost ratios for women with and without SMM were reported. Generalized linear models were used to analyze demographic and clinical variables influencing delivery costs. Results: We identified 1,486 women in the Commercial population, who had a birth in 2016 and met the criteria for SMM. The total mean per-patient costs of care for women with and without SMM were $50,212 and $23,795, respectively. In the Medicaid population there were 29,763 births, of which 342 met the criteria for SMM. The total mean per-patient costs of care for women with and without SMM were $26,513 and $9,652, respectively. A multifetal gestation, a cesarean delivery, maternal age, and pregnancy-related complications were independently predictive of increased delivery costs in both Commercial and Medicaid populations. Conclusions: The occurrence of SMM was associated with an increase in maternity-related costs of 111% in the Commercial and 175% in the Medicaid population. Some of the factors associated with increased delivery hospitalization costs could be treated or avoided.

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Severe Maternal Morbidity and Hospital Cost among Hospitalized Deliveries in the United States

Abstract: The hospital cost with any SMM was 2.1 times higher than those without any SMM. Our findings highlight the need to identify interventions and guide research efforts to mitigate the rate of SMM and its economic burden.

Cited by 24 publications

References 29 publications

Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US

Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US

Trends in Severe Maternal Morbidity in the US Across the Transition to ICD-10-CM/PCS From 2012-2019

Costs of Severe Maternal Morbidity in U.S. Commercially Insured and Medicaid Populations: An Updated Analysis

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