(107) Cost comparison of readmission versus proactive management of postpartum hypertensive disease with nifedipine

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: To determine costs associated with readmission compared to proactive inpatient management of postpartum hypertension disease.

Study Design: Secondary analysis of a retrospective cohort study evaluating 2020 data at a single tertiary care center. The primary outcome, readmission cost, was determined using mean cost of readmission for hypertensive disease and multiplying by number of patients readmitted. This was then compared to costs of implementing a protocol that would proactively treat hypertension postpartum to < 140/90 mmHg for at least 12 hours prior to discharge with nifedipine. Secondary outcomes included initial length of stay and utilization of nifedipine for hypertension treatment.

Results: Of 4972 total deliveries, 1172 (23.6%) patients with hypertension during their inpatient admission for labor were identified, 41 (3.5%) were readmitted for complications of hypertensive disease. Those readmitted were then stratified by whether normotension ( < 140/90 for at least 12 hours prior to discharge) was accomplished and whether they received nifedipine for treatment. Mean length of stay was determined in each group. (Figure 1). Of readmissions, 0/121 of those normotensive >12 hours prior to discharge and on nifedipine were readmitted. 51.2% (21/41) were both hypertensive at discharge and not on nifedipine, thus deemed potentially preventable readmissions. Mean cost of preventable readmission was $5307, totaling $111,447. The cost of treating all 411 of these patients with a 6-week prescription was $51,786. If combined with an additional 1 day stay for 0%, 25%, and 50% of patients, the respective total costs were $51,786, $111,381, and $170,976, respectively. (Figure 2).

Conclusion: Postpartum care for hypertensive patients that includes use of nifedipine to treat hypertension to < 140/90 mmHg for at least 12 hours prior to discharge is unlikely to increase the cost of care with potential significant reduction in maternal morbidity including readmission rate and its associated costs.

Primary & Presenting Author(s)

Alexis L. Rudnik, MD
HO4
University of Nebraska Medical Center
Omaha, Nebraska, United States

Coauthor(s)

JD
Joshua Dahlke, MD
Methodist Hospital
Omaha, Nebraska, United States
Todd R. Lovgren, MD
Attending Physician
Methodist Women's Hospital
Omaha, Nebraska, United States