title: Resource use trends in extracorporeal membrane oxygenation in adults: an analysis of the Nationwide Inpatient Sample 1998-2009.
abstract: OBJECTIVE
  The study objective was to determine whether significant trends over time have occurred in resource use associated with the use of extracorporeal membrane oxygenation in critically ill adults.
  
  
  METHODS
  All adult admissions involving extracorporeal membrane oxygenation were examined by using the Nationwide Inpatient Sample database (years 1998-2009). Trends in volume, outcome, and resource use (including hospital charges, length of stay, and charges per day) were analyzed.
  
  
  RESULTS
  An estimated total of 8753 admissions involved extracorporeal membrane oxygenation over the study period. Overall length of stay was 18.3 ± 1.3 days. Total hospital charges averaged $344,009 ± $30,707 per admission, with average charges per day of $40,588 ± $3099. Cumulative national charges for extracorporeal membrane oxygenation admissions increased significantly from $109.0 million in 1998 to $764.7 million in 2009 (P = .0016). Charges per patient and length of stay also increased significantly (P = .0032 and .0321, respectively). The increasing trend in the number of extracorporeal membrane oxygenation admissions during the study period was not statistically significant (P = .19). The post-cardiotomy group had more favorable outcomes and lower resource use. A shift was observed in the relative case-mix of extracorporeal membrane oxygenation admissions over the study period, with a relative decrease in the post-cardiotomy group and increases in the cardiogenic shock, respiratory failure, and lung transplant groups.
  
  
  CONCLUSIONS
  These results suggest that dramatic increases in resource use associated with extracorporeal membrane oxygenation are not solely the result of increased volume, but in part are due to a shift toward extracorporeal membrane oxygenation use in patient groups (other than in the post-cardiotomy setting) with greater resource use and worse outcomes.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: bmaxwell@jhu.edu.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Maxwell
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Powers
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Ahmad Y
authors.initials: AY
authors.lastname: Sheikh
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Peter H U
authors.initials: PH
authors.lastname: Lee
authors.affiliation: Department of Anesthesia, Cedars-Sinai Medical Center, Los Angeles, Calif.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Lobato
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Jim K
authors.initials: JK
authors.lastname: Wong
mesh_terms: D000328:Adult; D016638:Critical Illness; D016208:Databases, Factual; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics / Q000639:trends*; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006295:Health Resources / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000639:trends*; D018579:Patient Selection; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States