Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-24T11:32:02.672Z Has data issue: false hasContentIssue false
  • English
  • Français

Economic Impact of Ventilator-Associated Pneumonia in a Large Matched Cohort

Published online by Cambridge University Press:  02 January 2015

Marin H. Kollef ,
Cindy W. Hamilton  and
Frank R. Ernst
Marin H. Kollef*
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Cindy W. Hamilton
Affiliation:
Hamilton House, Virginia Beach, Virginia
Frank R. Ernst
Affiliation:
Premier Healthcare Alliance, Charlotte, North Carolina
*
Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the economic impact of ventilator-associated pneumonia (VAP) on length of stay and hospital costs.

Design.

Retrospective matched cohort study.

Setting.

Premier database of hospitals in the United States.

Patients.

Eligible patients were admitted to intensive care units (ICUs), received mechanical ventilation for ≥2 calendar-days, and were discharged between October 1, 2008, and December 31, 2009.

Methods.

VAP was defined by International Classification of Diseases, Ninth Revision (ICD-9), code 997.31 and ventilation charges for ≥2 calendar-days. We matched patients with VAP to patients without VAP by propensity score on the basis of demographics, administrative data, and severity of illness. Cost was based on provider perspective and procedural cost accounting methods.

Results.

Of 88,689 eligible patients, 2,238 (2.5%) had VAP; the incidence rate was 1.27 per 1,000 ventilation-days. In the matched cohort, patients with VAP (n = 2,144) had longer mean durations of mechanical ventilation (21.8 vs 10.3 days), ICU stay (20.5 vs 11.6 days), and hospitalization (32.6 vs 19.5 days; all P< .0001) than patients without VAP (n = 2,144). Mean hospitalization costs were $99,598 for patients with VAP and $59,770 for patients without VAP (P< .0001), resulting in an absolute difference of $39,828. Patients with VAP had a lower in-hospital mortality rate than patients without VAP (482/2,144 [22.5%] vs 630/2,144 [29.4%]; P<.0001).

Conclusions.

Our findings suggest that VAP continues to occur as defined by the new specific ICD-9 code and is associated with a statistically significant resource utilization burden, which underscores the need for cost-effective interventions to minimize the occurrence of this complication.

Infect Control Hosp Epidemiol 2012;33(3):250-256

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 3 , March 2012 , pp. 250 - 256
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Wier, L, Levit, K, Stranges, E, et al HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2008. Rockville, MD: Agency for Healthcare Research and Quality, 2010. http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/pdfs/FF_report_2008.pdf. Accessed June 8, 2011.Google Scholar
2. Rello, J, Ollendorf, DA, Oster, G, et al Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115–2121.Google Scholar
3. Buczko, W. Ventilator-associated pneumonia among elderly Medicare beneficiaries in long-term care hospitals. Health Care Financ Rev 2010;31:1–10.Google Scholar
4. Safdar, N, Dezfulian, C, Collard, HR, Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005;33:2184–2193.Google Scholar
5. Anderson, DJ, Kirkland, KB, Kaye, KS, et al Underresourced hospital infection control and prevention programs: penny wise, pound foolish? Infect Control Hosp Epidemiol 2007;28:767–773.CrossRefGoogle ScholarPubMed
6. Parsons, LS. Reducing bias in a propensity score matched-pair sample using greedy matching techniques. Proceedings of the Twenty-Sixth Annual SAS Users Group International Conference. Cary, NC: SAS Institute, 2001:214–226.Google Scholar
7. D'Agostino, RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 1998;17:2265–2281.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
8. Restrepo, MI, Anzueto, A, Arroliga, AC, et al Economic burden of ventilator-associated pneumonia based on total resource utilization. Infect Control Hosp Epidemiol 2010;31:509–515.Google Scholar
9. Melsen, WG, Rovers, MM, Bonten, MJ. Ventilator-associated pneumonia and mortality: a systematic review of observational studies. Crit Care Med 2009;37:2709–2718.Google ScholarPubMed
10. Craven, DE. Preventing ventilator-associated pneumonia in adults: sowing seeds of change. Chest 2006;130:251–260.CrossRefGoogle ScholarPubMed
11. Kollef, M. SMART approaches for reducing nosocomial infections in the ICU. Chest 2008;134:447–456.CrossRefGoogle ScholarPubMed
12. Bouadma, L, Mourvillier, B, Deiler, V, et al A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures. Crit Care Med 2010;38:789–796.CrossRefGoogle ScholarPubMed
13. Bouadma, L, Deslandes, E, Lolom, I, et al Long-term impact of a multifaceted prevention program on ventilator-associated pneumonia in a medical intensive care unit. Clin Infect Dis 2010;51:1115–1122.CrossRefGoogle Scholar
14. Zack, JE, Garrison, T, Trovillion, E, et al Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med 2002;30:2407–2412.CrossRefGoogle ScholarPubMed
15. Beyersmann, J, Kneib, T, Schumacher, M, Gastmeier, P. Nosocomial infection, length of stay, and time-dependent bias. Infect Control Hosp Epidemiol 2009;30:273–276.Google Scholar