Variation in Inpatient Admission for Management and Cost Drivers in Placenta Accreta Spectrum Disorder

OBJECTIVE: To assess variation in inpatient antepartum management strategies for placenta accreta spectrum (PAS) disorder and their association with hospitalization costs in a national sample. METHODS: This retrospective cohort study used the 2016–2021 Nationwide Readmissions Database to identify individuals aged 15–54 years who underwent cesarean hysterectomy for PAS between 23 and 35 weeks of gestation. Patients were categorized into four management groups based on whether they had a separate antepartum hospitalization and their predelivery length of stay (LOS) during the delivery hospitalization. Median total hospitalization costs (inclusive of separate antepartum and delivery hospitalization), adjusted to 2023 dollars, were analyzed as continuous and dichotomized outcomes (above the 90th percentile). Unadjusted and adjusted logistic and median regression models assessed whether inpatient management variation, postpartum LOS, demographic, and clinical factors influenced hospitalization costs. RESULTS: Among 3,237 individuals with PAS, 50.5% had no prior antepartum admission and a predelivery LOS of 2 days or less, 31.9% had no prior antepartum admission and a predelivery LOS of more than 2 days, 11.8% had a prior antepartum admission and a predelivery LOS of 2 days or less, and 5.8% had a prior antepartum admission and a predelivery LOS of more than 2 days. Median total hospitalization costs varied significantly by management group, with mean costs ranging from $21,829 to $51,039. Management variation was associated with nearly 3- to 29-times higher likelihood of high total hospitalization costs and $8,907–29,021 adjusted higher median cost depending on the specific management group. Of evaluated clinical factors, only disseminated intravascular coagulation was associated with an adjusted median cost increase of $12,921. CONCLUSION: Nearly one in five patients with PAS experienced an all-cause antepartum hospitalization. Variation in inpatient admission for management of PAS was evident in this national sample and was a significant driver of hospitalization costs. Although some antepartum hospitalizations and prolonged predelivery lengths of stay are unavoidable due to the complexity and severity of PAS, efforts to reduce unnecessary variations could reduce total hospitalization costs.