Comparison of hospital length of stay, costs, and readmissions of alteplase versus catheter replacement among patients with occluded central venous catheters.
BACKGROUND
Central venous catheter (CVC) occlusion is common, affecting 30% of all CVCs.


OBJECTIVE
To compare length of stay (LOS), costs, and readmissions associated with the use of alteplase to clear catheter blockage to outcomes associated with catheter replacement.


METHODS
Retrospective observational study utilizing a large hospital database.


METHODS
Hospitalized patients treated for catheter occlusion from January 2006 to December 2011.


METHODS
Univariate analyses of patient characteristics and treatment patterns and multivariable regression analyses of postocclusion hospital costs, LOS, and 30- and 90-day readmissions were conducted.


RESULTS
We included 34,579 patients treated for a CVC occlusion by replacement (N=1028) or by alteplase (2 mg) administration (N=33,551). Patients receiving alteplase were somewhat younger than those having catheter replacement (60 ± 19 vs 62 ± 20 years old, P=0.0002). After adjusting for patient and hospital factors via regression modeling, average daily postocclusion costs were $317 lower for alteplase recipients than for catheter replacement patients (95% confidence interval [CI]: 238.22-392.24; P<0.0001). Adjusted total postocclusion costs were $1419 lower for alteplase recipients versus patients receiving catheter replacement (95% CI: 307.27-2458.12; P=0.0121). Postocclusion operating room/surgery, radiology, and supply costs were significantly lower for alteplase recipients (P<0.001). Average adjusted postocclusion LOS was similar for both groups (P>0.05). Odds of readmission were not significantly different at 30 or 90 days.


CONCLUSIONS
Among patients treated for an occluded CVC, alteplase-treated patients had lower daily and total postocclusion costs than patients receiving catheter replacement. Cost differences were mainly driven by lower operating room/surgery, radiology, and supplier costs.
Premier Research Services, Premier Healthcare Alliance, Charlotte, North Carolina.
Frank R
FR
Ernst
Er
E
Chen
Craig
C
Lipkin
Darren
D
Tayama
Alpesh N
AN
Amin
D000293:Adolescent; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000191:economics*; D062905:Central Venous Catheters / Q000191:economics*; D003365:Costs and Cost Analysis; D020878:Device Removal / Q000191:economics*; D004868:Equipment Failure; D005260:Female; D005343:Fibrinolytic Agents / Q000494:pharmacology; D017721:Hospital Costs / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010359:Patient Readmission / Q000639:trends*; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000494:pharmacology*; D020246:Venous Thrombosis / Q000191:economics / Q000517:prevention & control; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator