[Complete cost of surgery for postpartum haemorrhage].
OBJECTIVE
Reduction of maternal mortality is a major priority in the public health domain. One of the main causes of maternal mortality is postpartum haemorrhage. Because economic pressures favour the use of less expensive strategies, it is becoming now critical to know exactly the cost of the surgical procedures involved in the treatment of postpartum haemorrhage, in order to provide future guidelines in Implementing reforms in hospital.


METHODS
Evaluation was made on multiple data collected in the Gynecology-Obstetrics and Central Sterile Supplies departments of a tertiary care Hospital. Analysis of the production costs was made based on the actual costs. The receipts were figured on the basis of applicable reimbursement in France in 2005, taking into account the financial decisions of the producers.


RESULTS
From January 2004 to December 2005, 262 patients were treated for postpartum hemorrhage and patients files were available for review in 255 cases. Of these, surgery was performed in 52 cases. The costs of surgery in the postpartum care ranged from 275.04 euro per manual exploration of the uterine cavity (n=8), 302.48 euro per exploration with valve (n=26), 601.55 euro per vascular ligation (n=3), 725.53 euro per vaginal packing or unpacking (n=10) to 875.06 euro per hysterectomy (n=5). Cleaning and sterilizing of surgical instruments represented a substantial burden, ranging from 7.5% to 11.4% of the total cost of surgery.


CONCLUSIONS
The costs of surgery for postpartum haemorrhage have been calculated to provide future guidelines for the directions and follow-up of these activities in light of the T2A-EPRD and poles of activity. The actual costs could be used to determine the bases of one or more French DRGs (PMSI) "postpartum hemorrhage" evolution.
Castiel
D
D
Département des sciences sanitaires et sociales, université Paris-Nord, UFR SMBH, 74, rue Marcel-Cachin, 93017 Bobigny cedex, France.
Bréchat
P-H
PH
Benoît
B
B
Nguon
B
B
Gayat
E
E
Soyer
P
P
Rymer
R
R
Barranger
E
E
D000328:Adult; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics*; D008427:Maternal Health Services / Q000191:economics*; D006473:Postpartum Hemorrhage / Q000401:mortality / Q000601:surgery*; D017410:Practice Guidelines as Topic