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Concerns about the health of newborns discharged too early from the hospital have led the Federal Government and most State legislatures to pass laws mandating minimum 48-hour hospital stays following vaginal deliveries and 96 hours following cesarean sections. A 12-hour increase in length of hospital stay could reduce the newborn readmission rate by 0.6 percentage point or twice as much as estimates obtained using conventional statistical methods, concludes a study supported by the Agency for Healthcare Research and Quality (HS09342). Since there are about 3.9 million births each year in the United States, a 0.6 percentage point reduction in the readmission rate implies 23,400 fewer newborn readmissions.
These readmissions are costly, may reduce mother-infant bonding, and may increase parents' anxiety, notes Jesse D. Malkin, Ph.D., of Covance Health Economics and Outcomes Services, Inc. In a large retrospective study of postpartum length of stay, Dr. Malkin and his colleagues analyzed data on more than two-thirds of the births in Washington State in 1989 and 1990 to determine the effect of postpartum length of stay on newborn readmission. The data used in this study were collected by the AHRQ-supported Patient Outcomes Research Team on Management and Outcomes of Childbirth (PORT Contract 290-90-0039). The researchers compared the predicted probability of readmission for newborns with 39-hour stays (the mean among vaginally delivered newborns in the sample) with the predicted probability of readmission for newborns with 51-hour stays, that is, a 12-hour increase.
Dr. Malkin and his colleagues used hour of birth and method of delivery as instrumental variables influencing length of stay. Hour of birth influences length of stay because it affects whether a newborn will spend an extra night in the hospital. Method of delivery influences length of stay because mothers need more time to recuperate after a cesarean section than a vaginal delivery, and newborns are rarely discharged before their mothers.
See "Do longer postpartum stays reduce newborn readmissions? Analysis using instrumental variables," by Dr. Malkin, Michael S. Broder, M.D., M.S.H.S., and Emmett Keeler, Ph.D., in the December 2000 Health Services Research 35, pp. 1071-1091.
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