An economic analysis of trial of labor after cesarean delivery.
OBJECTIVE
Given that cesarean delivery is one of the most commonly performed surgical procedures in the United States and an important contributor to obstetric care costs, this analysis sought to examine maternal hospital costs associated with trial of labor after cesarean delivery (TOLAC) versus repeat cesarean delivery (RCD).


METHODS
A national sample was used to identify women with singleton pregnancy who underwent either TOLAC or RCD from 2006 to 2012. Women with diagnoses that could confound cost via extended hospital length of stay prior to delivery were excluded. Other medical and obstetric covariates that could influence cost were included in an adjusted model.


RESULTS
A total of 485,247 women were identified, including 365,596 (75.3%) cesarean deliveries without labor, 41,988 (8.6%) successful and 77,663 (16.0%) unsuccessful TOLAC deliveries. The inflation-adjusted median costs in this cohort were $5512 for cesarean without labor, $4175 for successful TOLAC, $5166 for all TOLAC attempts, and $5759 for failed TOLAC. In a multivariable model, hospital region was a major predictor of median cost as were demographic variables and medical comorbidities.


CONCLUSION
TOLAC is associated with modest reductions of cost for maternal hospitalizations. However, other medical, demographic and hospital factors appear to be more important factors.
['Friedman|Alexander M|AM|', 'Ananth|Cande V|CV|', 'Chen|Ling|L|', "D'Alton|Mary E|ME|", 'Wright|Jason D|JD|']
D000293:Adolescent D000328:Adult D017604:Cesarean Section, Repeat D003362:Cost-Benefit Analysis D005260:Female D006801:Humans D007231:Infant, Newborn D007902:Length of Stay D008875:Middle Aged D007744:Obstetric Labor Complications D011247:Pregnancy D012307:Risk Factors D014219:Trial of Labor D014481:United States D014597:Uterine Rupture D016064:Vaginal Birth after Cesarean D055815:Young Adult
Cesarean cost obstetric quality