title: An economic analysis of trial of labor after cesarean delivery.
abstract: 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.
  
  
  CONCLUSIONS
  TOLAC is associated with modest reductions of cost for maternal hospitalizations. However, other medical, demographic and hospital factors appear to be more important factors.
authors: a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and.
authors: Alexander M
authors: AM
authors: Friedman
authors: a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and.|b Department of Epidemiology , Joseph L. Mailman School of Public Health, Columbia University , New York , NY , USA.
authors: Cande V
authors: CV
authors: Ananth
authors: a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and.
authors: Ling
authors: L
authors: Chen
authors: a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and.
authors: Mary E
authors: ME
authors: D'Alton
authors: a Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology , Columbia University College of Physicians and Surgeons , New York , NY , USA and.
authors: Jason D
authors: JD
authors: Wright
mesh_terms: D000293:Adolescent; D000328:Adult; D017604:Cesarean Section, Repeat / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000191:economics* / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D014219:Trial of Labor; D014481:United States / Q000453:epidemiology; D014597:Uterine Rupture / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Cesarean; cost; obstetric quality