title: Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center.
abstract: OBJECTIVE
  To determine the attributable cost of ventilator-associated pneumonia from a hospital-based cost perspective, after adjusting for potential confounders.
  
  
  METHODS
  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.
  
  
  METHODS
  The medical and surgical intensive care units at a suburban, tertiary care hospital.
  
  
  METHODS
  Patients requiring >24 hrs of mechanical ventilation.
  
  
  METHODS
  None.
  
  
  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.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA. dwarren@im.wustl.edu
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
authors.forename: Sunita J
authors.initials: SJ
authors.lastname: Shukla
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cox
authors.forename: Max M
authors.initials: MM
authors.lastname: Cohen
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015986:Confounding Factors, Epidemiologic; D017281:Cost of Illness; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D016519:Hospitals, Religious / Q000191:economics; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000191:economics* / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D019036:Suburban Health Services / Q000191:economics