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Critical Care |

Influence of Ventilator-Associated Pneumonia on Length of Stay for Hospitalized Patient Requiring Mechanical Ventilation: A Nationwide Analysis

Ronak Soni; Kathan Mehta, MPH; Tapan Mehta, MPH; Khushboo Sheth; Zeeshan Mansuri, MPH; Longjian Liu, PhD
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Government Medical College Surat, Surat, India


Chest. 2014;146(4_MeetingAbstracts):206A. doi:10.1378/chest.1994914
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Abstract

SESSION TITLE: ARDS/Lung Injury Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 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 length of stay (LOS) is largely lacking.

METHODS: We queried the Healthcare Cost and Utilization Project’s 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). Using SAS 9.2, Survey procedures were used to identify multivariate predictors of LOS, 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 LOS was 15.4 days. The patients who developed VAP had significantly higher LOS (30.9 days vs. 15.2 days, p<0.001) as compared to patients without VAP. After controlling for confounders, the independent predictors of increased LOS were mechanical ventilation for more than 96 hours (+16.1 days), VAP (+7.7 days), urban location of hospital (2.5 days), and teaching hospital status (+1.5 days). The independent predictor of decreased LOS was charity care or no insurance (-4.8 days). In the study period of 4 years, VAP lead to 496,411 (estimated) additional days of hospitalization.

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 longer LOS, VAP significantly increases LOS by approximately 1 week per patient which leads to significant burden on health care utilization in United States (US). Preventive strategy to stop development of VAP can help to reduce LOS of hospitalized patients on mechanical ventilation and reduce the burden on health care system.

CLINICAL IMPLICATIONS: Aggressive measures to prevent VAP are required to decrease healthcare utilization by patients on mechanical ventilation; which in turn, can reduce financial burden on health care system.

DISCLOSURE: The following authors have nothing to disclose: Ronak Soni, Kathan Mehta, Tapan Mehta, Khushboo Sheth, Zeeshan Mansuri, Longjian Liu

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