SESSION TITLE: Quality & Clinical Improvement II
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 28, 2014 at 11:00 AM - 12:15 PM
PURPOSE: Ventilator Associated Pneumonia (VAP) is an important cause of morbidity and mortality in hospitalized patients requiring mechanical ventilation. While impact of VAP on all-cause mortality is extensively studied in past, the contemporary data for impact of VAP on Cost of hospitalization is largely lacking.
METHODS: We queried the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample (NIS) between 2008 and 2011 using the ICD-9 procedure code of 96.70, 96.71 and 96.72 for mechanical ventilation. The patients who developed VAP were identified by ICD9- diagnosis code of 997.31. Severity of co-morbidities was determined using Deyo modification of Charlson co-morbidity index (CCI). Cost of care was calculated by multiplying total charges for hospitalization with cost-to-charge ratios provided by HCUP. The cost was also adjusted for inflation using Consumer Price Index (CPI) published by Bureau of Labor Statistics. Using SAS 9.2, Survey procedures were used to identify multivariate predictors of cost, accommodating hierarchical two stage cluster design of NIS.
RESULTS: A total of 905,035 patients (Weighted N = 4,466,028) who required mechanical ventilation were available for analysis, out of which 13,082 developed VAP (Weighted N = 64,469). The average cost of hospitalization was $44,888. The patients who developed VAP had significantly higher cost of hospitalization ($98,386 vs. $44,098, p<0.001) as compared to patients without VAP. After controlling for confounders, the independent predictors of increased cost of hospitalization were mechanical ventilation for more than 96 hours (+$47,140), VAP (+$28,257), and CCI >= 2 (+$3,620). Independent predictors of decreased cost of hospitalization were charity care or no insurance (-$7,192) and hospital in west region (-$9,561). In the study period of 4 years, VAP has, approximately, costed $1.8 billion to United States (US) health care system.
CONCLUSIONS: Our study provides analysis of one of the largest sample of patients on mechanical ventilation. While requirement of mechanical ventilation more than 96 hours is the strongest predictor of higher cost, VAP significantly increases cost of hospitalization by $28,257 per patient which lead to estimated $1.8 billion additional burden to US health care system from 2008 to 2011.
CLINICAL IMPLICATIONS: In the era of cost conscious care, preventing VAP could save millions of dollars every year. More efforts are needed to establish preventive measure for VAP.
DISCLOSURE: The following authors have nothing to disclose: Ronak Soni, Kathan Mehta, Tapan Mehta, Khushboo Sheth, Zeeshan Mansuri, Longjian Liu
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