Costs of Venous Thromboembolism, Catheter-Associated Urinary Tract Infection, and Pressure Ulcer

Abstract

OBJECTIVE: To estimate differences in the length of stay (LOS) and costs for comparable pediatric patients with and without venous thromboembolism (VTE), catheter-associated urinary tract infection (CAUTI), and pressure ulcer (PU). METHODS:We identified at-risk children 1 to 17 years old with inpatient discharges in the Nationwide Inpatient Sample. We used a high dimensional propensity score matching method to adjust for case-mix at the patient level then estimated differences in the LOS and costs for comparable pediatric patients with and without VTE, CAUTI, and PU.RESULTS: Incidence rates were 32 (VTE), 130 (CAUTI), and 3 (PU) per 10 000 at-risk patient discharges. Patients with VTE had an increased 8.1 inpatient days (95% confidence interval [CI]: 3.9 to 12.3) and excess average costs of $27 686 (95% CI: $11 137 to $44 235) compared with matched controls. Patients with CAUTI had an increased 2.4 inpatient days (95% CI: 1.2 to 3.6) and excess average costs of $7200 (95% CI: $2224 to $12 176). No statistical differences were found between patients with and without PU. CONCLUSIONS:The significantly extended LOS highlights the substantial morbidity associated with these potentially preventable events. Hospitals seeking to develop programs targeting VTE and CAUTI should consider the improved turnover of beds made available by each event prevented. WHAT'S KNOWN ON THIS SUBJECT:In adults, there is significant increased length of stay, cost, and/or resource use associated with hospitalacquired conditions. Less is known about the epidemiology and impact of many hospitalacquired conditions in pediatric populations. WHAT THIS STUDY ADDS:We find increased pediatric length of stay and costs due to venous thromboembolism and catheter-associated urinary tract infections. This is essential information for hospital administrators and safety departments who are planning interventions to reduce harm associated with these hospital-acquired conditions.

Rising Vancomycin-Resistant Enterococcus Infections in Hospitalized Children in the United States

“…20 This method has previously been used in evaluating disease outcomes for other hospital-acquired infections. [21][22][23] VRE infection was the dependent variable, and demographic variables, hospital/ geographic variables, and 389 of the most common comorbid diagnostic and procedure CCS codes, as discussed previously, were the independent variables in the model. Patients with an indication of VRE infection (cases) were matched by high-dimensional propensity score, using a greedy matching algorithm, to patients who did not have VRE (controls), with a 1-to-5 matching ratio.…”

Epidemiology and Risk Assessment of Pediatric Venous Thromboembolism

“…While recent data have highlighted extended LOS following HA-VTE, the mechanism by which prolonged hospitalization increases risk is less clear (2). Compounding the challenge are differences in analysis.…”

“…As the second leading cause of hospital-acquired morbidity (preventable harm) for children in the U.S., VTE significantly increases hospitalization costs. Using the nationwide inpatient sample, one recent analysis estimated increased mean hospital costs of $27,686 and mean length of stay (LOS) extension of 8.1 days in children with hospital-acquired VTE (HA-VTE) compared to controls (2). …”

Recommendations for venous thromboembolism prophylaxis in pediatric trauma patients

“…Children with hospital-acquired VTE have increased length of stay and excess costs of $27,000. 9 Several risk factors have been associated with VTE in injured children, including older age, injury severity, obesity, central venous catheter (CVC) use, mechanical ventilation, inotrope use, blood transfusion, pelvic or lower extremity fracture, spinal cord injury, and intensive care unit stay. 2,4,7Y13 However, it is not clear in any individual pediatric patient when the benefit of pharmacologic prophylaxis to reduce the risk of VTE outweighs the risk, particularly the risk of bleeding.…”