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Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center.
Crit Care Med. 2003 May; 31(5):1312-7.CC

Abstract

OBJECTIVE

To determine the attributable cost of ventilator-associated pneumonia from a hospital-based cost perspective, after adjusting for potential confounders.

DESIGN

Patients admitted between January 19, 1998, and December 31, 1999, were followed prospectively for the occurrence of ventilator-associated pneumonia. Hospital costs were defined by using the hospital cost accounting database.

SETTING

The medical and surgical intensive care units at a suburban, tertiary care hospital.

PATIENTS

Patients requiring >24 hrs of mechanical ventilation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We measured occurrence of ventilator-associated pneumonia, in-hospital mortality rate, total intensive care unit (ICU) and hospital lengths of stay (LOS), and total hospital cost per patient. Ventilator-associated pneumonia occurred in 127 of 819 patients (15.5%). Compared with uninfected, ventilated patients, patients with ventilator-associated pneumonia had a higher Acute Physiology and Chronic Health Evaluation II score on admission (p <.001) and were more likely to require multiple intubations (p <.001), hemodialysis (p <.001), tracheostomy (p <.001), central venous catheters (p <.001), and corticosteroids (p <.001). Patients with ventilator-associated pneumonia were more likely to be bacteremic during their ICU stay (36 [28%] vs. 22 [3%]; p <.001). Patients with ventilator-associated pneumonia had significantly higher unadjusted ICU LOS (26 vs. 4 days; p <.001), hospital LOS (38 vs. 13 days; p <.001), mortality rate (64 [50%] vs. 237 [34%]; p <.001), and hospital costs (70,568 dollars vs. 21,620 dollars, p <.001). Multiple linear regression, controlling for other factors that may affect costs, estimated the attributable cost of ventilator-associated pneumonia to be 11,897 dollars (95% confidence interval = 5,265 dollars-26,214 dollars; p <.001).

CONCLUSIONS

Patients with ventilator-associated pneumonia had significantly longer ICU and hospital LOS, with higher crude hospital cost and mortality rate compared with uninfected patients. After we adjusted for underlying severity of illness, the attributable cost of ventilator-associated pneumonia was approximately 11,897 dollars.

Authors+Show Affiliations

Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA. dwarren@im.wustl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12771596

Citation

Warren, David K., et al. "Outcome and Attributable Cost of Ventilator-associated Pneumonia Among Intensive Care Unit Patients in a Suburban Medical Center." Critical Care Medicine, vol. 31, no. 5, 2003, pp. 1312-7.
Warren DK, Shukla SJ, Olsen MA, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med. 2003;31(5):1312-7.
Warren, D. K., Shukla, S. J., Olsen, M. A., Kollef, M. H., Hollenbeak, C. S., Cox, M. J., Cohen, M. M., & Fraser, V. J. (2003). Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Critical Care Medicine, 31(5), 1312-7.
Warren DK, et al. Outcome and Attributable Cost of Ventilator-associated Pneumonia Among Intensive Care Unit Patients in a Suburban Medical Center. Crit Care Med. 2003;31(5):1312-7. PubMed PMID: 12771596.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. AU - Warren,David K, AU - Shukla,Sunita J, AU - Olsen,Margaret A, AU - Kollef,Marin H, AU - Hollenbeak,Christopher S, AU - Cox,Michael J, AU - Cohen,Max M, AU - Fraser,Victoria J, PY - 2003/5/29/pubmed PY - 2003/6/17/medline PY - 2003/5/29/entrez SP - 1312 EP - 7 JF - Critical care medicine JO - Crit Care Med VL - 31 IS - 5 N2 - OBJECTIVE: To determine the attributable cost of ventilator-associated pneumonia from a hospital-based cost perspective, after adjusting for potential confounders. DESIGN: Patients admitted between January 19, 1998, and December 31, 1999, were followed prospectively for the occurrence of ventilator-associated pneumonia. Hospital costs were defined by using the hospital cost accounting database. SETTING: The medical and surgical intensive care units at a suburban, tertiary care hospital. PATIENTS: Patients requiring >24 hrs of mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured occurrence of ventilator-associated pneumonia, in-hospital mortality rate, total intensive care unit (ICU) and hospital lengths of stay (LOS), and total hospital cost per patient. Ventilator-associated pneumonia occurred in 127 of 819 patients (15.5%). Compared with uninfected, ventilated patients, patients with ventilator-associated pneumonia had a higher Acute Physiology and Chronic Health Evaluation II score on admission (p <.001) and were more likely to require multiple intubations (p <.001), hemodialysis (p <.001), tracheostomy (p <.001), central venous catheters (p <.001), and corticosteroids (p <.001). Patients with ventilator-associated pneumonia were more likely to be bacteremic during their ICU stay (36 [28%] vs. 22 [3%]; p <.001). Patients with ventilator-associated pneumonia had significantly higher unadjusted ICU LOS (26 vs. 4 days; p <.001), hospital LOS (38 vs. 13 days; p <.001), mortality rate (64 [50%] vs. 237 [34%]; p <.001), and hospital costs (70,568 dollars vs. 21,620 dollars, p <.001). Multiple linear regression, controlling for other factors that may affect costs, estimated the attributable cost of ventilator-associated pneumonia to be 11,897 dollars (95% confidence interval = 5,265 dollars-26,214 dollars; p <.001). CONCLUSIONS: Patients with ventilator-associated pneumonia had significantly longer ICU and hospital LOS, with higher crude hospital cost and mortality rate compared with uninfected patients. After we adjusted for underlying severity of illness, the attributable cost of ventilator-associated pneumonia was approximately 11,897 dollars. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/12771596/Outcome_and_attributable_cost_of_ventilator_associated_pneumonia_among_intensive_care_unit_patients_in_a_suburban_medical_center_ L2 - https://dx.doi.org/10.1097/01.CCM.0000063087.93157.06 DB - PRIME DP - Unbound Medicine ER -