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Trends in Mortality and Costs of Pediatric Extracorporeal Life Support
Yas Sanaiha1, Jonathan J Khoubian1,2, Catherine G Williamson1
1Cardiovascular Outcomes Research Laboratory, Division of Cardiac Surgery, and.
Insights
Pediatric extracorporeal life support (ECLS) use surged 329% from 2008-2015. Survival improved significantly, but hospital costs rose substantially despite stable length of stay.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary support technologies
- Health services research
Background:
- Extracorporeal life support (ECLS) is a vital therapy for critically ill pediatric patients.
- Established for over three decades, ECLS addresses diverse medical indications.
- This study focuses on pediatric ECLS hospitalizations, analyzing key utilization and outcome metrics.
Purpose of the Study:
- To investigate trends in the utilization of ECLS in pediatric hospitalizations.
- To analyze changes in mortality rates, length of hospital stay (LOS), and associated costs.
- To identify patterns in ECLS use for various pediatric conditions.
Main Methods:
- A retrospective cohort study design was employed.
- Data from the National Inpatient Sample (2008-2015) were analyzed for pediatric patients (28 days to <21 years) receiving ECLS.
- Statistical trend analyses, including nonparametric and Cochran-Armitage tests, were used to assess mortality, LOS, and costs.
Main Results:
- ECLS hospitalizations increased by 329% (11 to 46 per 100,000 pediatric hospitalizations) between 2008 and 2015.
- Indications included respiratory failure (36.4%), postcardiotomy syndrome (25.9%), and cardiogenic shock (13.1%).
- Overall mortality decreased from 50.3% to 34.6% (P < .001), while adjusted hospital costs significantly increased ($214,046 to $324,841; P = .002) with a stable LOS (46 to 44 days; P = .94).
Conclusions:
- Pediatric ECLS utilization has markedly increased, accompanied by significant improvements in survival rates.
- Despite stable length of stay, hospital costs associated with pediatric ECLS have risen substantially.
- Ongoing analysis of ECLS use trends is crucial for quality improvement initiatives in managing this life-saving technology.
Background:
Extracorporeal life support (ECLS) has been used for >30 years as a life-sustaining therapy in critically ill patients for a variety of indications. In the current study, we aimed to examine trends in use, mortality, length of stay (LOS), and costs for pediatric ECLS hospitalizations.
Methods:
We performed a retrospective cohort study of pediatric patients (between the ages of 28 days and <21 years) on ECLS using the 2008-2015 National Inpatient Sample, the largest all-payer inpatient hospitalization database generated from hospital discharges. Nonparametric and Cochran-Armitage tests for trend were used to study in-hospital mortality, LOS, and hospitalization costs.
Results:
Of the estimated 5847 patients identified and included for analysis, ECLS was required for respiratory failure (36.4%), postcardiotomy syndrome (25.9%), mixed cardiopulmonary failure (21.7%), cardiogenic shock (13.1%), and transplanted graft dysfunction (2.9%). The rate of ECLS hospitalizations increased 329%, from 11 to 46 cases per 100 000 pediatric hospitalizations, from 2008 to 2015 (P < .001). Overall mortality decreased from 50.3% to 34.6% (P < .001). Adjusted hospital costs increased significantly ($214 046 ± 11 822 to 324 841 ± 25 621; P = .002) during the study period despite a stable overall hospital LOS (46 ± 6 to 44 ± 4 days; P = .94).
Conclusions:
Use of ECLS in pediatric patients has increased with substantially improved ECLS survival rates. Hospital costs have increased significantly despite a stable LOS in this group. Dissemination of this costly yet life-saving technology warrants ongoing analysis of use trends to identify areas for quality improvement.
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