Emergency department burden of hyperemesis gravidarum in the United States from 2006 to 2014

Grace Geeganage; Johanna Iturrino; Scott A Shainker; Sarah Ballou; Vikram Rangan; Judy Nee

doi:10.1016/j.xagr.2023.100166

Emergency department burden of hyperemesis gravidarum in the United States from 2006 to 2014

AJOG Glob Rep. 2023 Jan 28;3(1):100166. doi: 10.1016/j.xagr.2023.100166. eCollection 2023 Feb.

Authors

Grace Geeganage¹, Johanna Iturrino¹, Scott A Shainker², Sarah Ballou¹, Vikram Rangan¹, Judy Nee¹

Affiliations

¹ Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Ms Geeganage and Drs Iturrino, Ballou, Rangan, and Nee).
² Division of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Dr Shainker).

Abstract

Background: Hyperemesis gravidarum is the most severe form of nausea and vomiting of pregnancy, potentially affecting both maternal and pregnancy health. Hyperemesis gravidarum often results in emergency department visits, although the exact frequency and costs associated with these visits have not been well studied.

Objective: This study aimed to analyze the trends in hyperemesis gravidarum emergency department visits, inpatient admissions, and the associated costs between 2006 and 2014.

Study design: Patients were identified from the 2006 and 2014 Nationwide Emergency Department Sample database files using International Classification of Diseases, Ninth Revision diagnosis codes. Patients with a primary diagnosis of hyperemesis gravidarum, nausea and vomiting of pregnancy, and all nondelivery pregnancy-related diagnoses (all antepartum visits) were identified. All groups were analyzed; trends in demographics, number of emergency department visits, and visit costs were compared. Costs were inflation-adjusted to 2021 US dollars.

Results: Emergency department visits for hyperemesis gravidarum increased by 28% from 2006 to 2014; however, the proportion of those who were subsequently admitted to the hospital decreased. The average cost of an emergency department visit for hyperemesis gravidarum increased by 65% ($2156 to $3549), as opposed to an increase of 60% for all antepartum visits ($2218 to $3543). The aggregate cost for all hyperemesis gravidarum visits increased by 110% ($383,681,346 to $806,696,513) from 2006 to 2014, which was similar to the increase observed for all antepartum emergency department visits.

Conclusion: From 2006 to 2014, emergency department visits for hyperemesis gravidarum increased by 28%, with associated costs increasing by 110%, whereas the number of admissions from the emergency department for hyperemesis gravidarum decreased by 42%.

Keywords: Nationwide Emergency Department Sample; healthcare utilization; medical economics; nausea and vomiting of pregnancy.