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Prolonged acute mechanical ventilation, hospital resource utilization, and mortality in the United States
Marya D Zilberberg1, Rose S Luippold, Sandra Sulsky
1University of Massachusetts, School of Public Health and Health Sciences, Amherst, MA, USA. mzilberb@schoolph.umass.edu
Objective:
Adjusted costs of mechanical ventilation (MV) are $1,500 per patient-day. We compared the prevalence, characteristics, and outcomes of MV < 96 hrs (MV < 96) and prolonged acute MV (PAMV) of > or = 96 hrs' duration in a representative sample of U.S. hospital discharges.
Design:
A multicenter cross-sectional study.
Setting:
Nationally representative sample of U.S. hospital discharges.
Patients:
Adult hospital discharges were identified from the 2003 Nationwide Inpatient Sample, Healthcare Cost and Utilization Project from the Agency for Healthcare Research and Quality (AHRQ). PAMV was based on the presence of ICD-9 code 96.72, and MV < 96 hrs based on ICD-9 codes 96.70 and 96.71.
Interventions:
None.
Measurements And Main Results:
Of 31,340,578 discharges for adults (> or = 18 yrs), 2.4% had any MV, of which 469,168 (61%) had MV < 96, and 294,333 (39%) had PAMV. Patient demographics were similar for MV < 96 and PAMV. With the exception of acute myocardial infarction and chronic and end-stage renal disease without dialysis, the prevalence of coexisting conditions was higher in the PAMV group. Median length of stay (17 vs. 6 days) and hospital costs ($40,903 vs. $13,434) also were higher with PAMV vs. MV < 96. Although Agency for Healthcare Research and Quality disease severity and mortality probability were higher in the PAMV than MV < 96 group, actual mortality was similar between the two groups (34% vs. 35%).
Conclusions:
There were nearly 300,000 PAMV discharges in the United States in 2003 at an annual aggregated hospital cost of > $16 billion, or nearly two thirds of the cost for all of the MV discharges. Despite a higher predicted mortality, patients requiring PAMV had the same likelihood of being discharged alive as those on shorter-term MV. These analyses will help inform health care decision-making and resource planning in the face of an aging population.
Insights
Prolonged acute mechanical ventilation (PAMV) in U.S. adults cost over $16 billion in 2003, despite similar survival rates compared to short-term mechanical ventilation (MV). These findings highlight significant costs associated with PAMV, informing future healthcare resource planning.
Area of Science:
- Critical Care Medicine
- Health Economics
- Health Services Research
Background:
- Mechanical ventilation (MV) is a critical intervention in intensive care.
- Understanding the costs and outcomes of different MV durations is essential for healthcare management.
- Adjusted costs for MV are approximately $1,500 per patient-day.
Purpose of the Study:
- To compare the prevalence, characteristics, and outcomes of short-term MV (<96 hours) versus prolonged acute MV (PAMV, ≥96 hours).
- To analyze the associated hospital costs and patient demographics for both MV groups.
- To inform healthcare decision-making and resource planning regarding mechanical ventilation strategies.
Main Methods:
- A multicenter, cross-sectional study utilizing a nationally representative sample of U.S. adult hospital discharges from the 2003 Nationwide Inpatient Sample.
- Patients were categorized into MV < 96 hours (using ICD-9 codes 96.70, 96.71) and PAMV (using ICD-9 code 96.72).
- Data analysis included patient demographics, coexisting conditions, length of stay, hospital costs, and mortality.
Main Results:
- Out of over 31 million adult discharges, 2.4% received MV, with 61% on MV < 96 hours and 39% on PAMV.
- PAMV patients had a higher prevalence of coexisting conditions, longer median length of stay (17 vs. 6 days), and higher median hospital costs ($40,903 vs. $13,434) compared to MV < 96.
- Despite higher predicted mortality in the PAMV group, actual mortality rates were similar (34% vs. 35%) between the two groups.
Conclusions:
- In 2003, prolonged acute mechanical ventilation accounted for nearly 300,000 U.S. discharges and over $16 billion in hospital costs, representing two-thirds of all MV costs.
- Patients requiring PAMV had similar survival likelihoods to those on shorter-term MV, despite higher predicted mortality.
- These findings underscore the substantial economic burden of PAMV and are crucial for future healthcare resource allocation, especially with an aging population.
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