Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?
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  • 作者：Carolyn F Weiniger (1) (2)
    Paul S Spencer (3)
    Yuval Weiss (4)
    Gary Ginsberg (5)
    Yossef Ezra (6)
  • 关键词：Breech ; Cesarean delivery ; Costs ; Neuraxial blockade ; Spinal
  • 刊名：Israel Journal of Health Policy Research
  • 出版年：2014
  • 出版时间：December 2014
  • 年：2014
  • 卷：3
  • 期：1
  • 全文大小：236 KB
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  • 作者单位：Carolyn F Weiniger (1) (2)
    Paul S Spencer (3)
    Yuval Weiss (4)
    Gary Ginsberg (5)
    Yossef Ezra (6)

    1. Department of Anesthesiology and Critical Care Medicine Hadassah-Hebrew, University Medical Center, Ein Kerem, Jerusalem, 91120, Israel
    2. Department of Anesthesia, Stanford School of Medicine, Stanford, CA, USA
    3. Department of Electrical Engineering & Computer Sciences, University of California at Berkley, California, USA
    4. Hospital administration, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel
    5. Department of Medical Technology Assessment, Ministry of Health, Jerusalem, Israel
    6. Department of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
  • ISSN：2045-4015
文摘
Background External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery. Methods In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS. Results Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs. Conclusions The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate.

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