Cocanour Christine S, Ostrosky-Zeichner Luis, Peninger Michelle, Garbade Debbi, Tidemann Tommy, Domonoske Bradley D, Li Tao, Allen Steven J, Luther Katharine M
University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.
Surg Infect (Larchmt). 2005 Spring;6(1):65-72. doi: 10.1089/sur.2005.6.65.
Nosocomial pneumonia and especially ventilator-associated pneumonia (VAP) are costly complications for the hospitalized patient. Nosocomial pneumonia has been estimated to cost $5,000 per episode, but the specific cost for a VAP has not been well estimated. As part of a successful performance improvement program in decreasing VAP from 10 VAPs/100 ICU admissions to 2.5 VAPs/100 ICU admissions, we examined the costs associated with VAP.
From January 1, 2002, through September 30, 2003, Shock Trauma Intensive Care Unit patients and charts were reviewed concurrently by an infection control practitioner for development of VAP as defined by National Nosocomial Infection Surveillance (NNIS) guidelines. Costs were obtained from the hospital's cost accounting software Transition Systems version 3.1.01 (TSI). All patients requiring greater than one day of mechanical ventilation were evaluated. Seventy patients with VAP and 70 patients without VAP were matched according to age and Injury Severity Score. Differences were compared using Kruskal-Wallis and two sample T-tests. Significance was considered for p < 0.05.
The ICU cost difference was significant (p < 0.05) between the case-controlled patients with VAP ($82,195) and those without VAP ($25,037). There was also a significant increase in ICU length of stay (21.6 versus 6.4 days) and the number of ventilator days (17.7 versus 5.8; both, p < 0.05). Mortality was not different in the case-controlled population. A substantial portion of the increased cost of a VAP was from the increase in ICU length of stay ($1,861/day). Pharmacy, respiratory and "other" also accounted for the increases when cost distribution was analyzed. This translates into a cost avoidance of approximately $428,685 per 100 admissions to the ICU.
Ventilator-associated pneumonia not only leads to a significant increase in ventilator days and ICU length of stay, but adds substantially to hospital costs. In our ICU, an episode of VAP costs $57,000 per occurrence.
医院获得性肺炎，尤其是呼吸机相关性肺炎（VAP），对于住院患者来说是代价高昂的并发症。据估计，医院获得性肺炎每次发作的费用为5000美元，但VAP的具体费用尚未得到准确估算。作为一项成功的质量改进项目的一部分，我们将VAP发生率从每100例重症监护病房（ICU）入院患者中的10例降低至2.5例，在此过程中，我们对与VAP相关的费用进行了研究。
从2002年1月1日至2003年9月30日，感染控制专员同时审查了休克创伤重症监护病房患者及其病历，以确定是否发生了符合国家医院感染监测（NNIS）指南定义的VAP。费用数据来自医院的成本核算软件Transition Systems版本3.1.01（TSI）。对所有需要机械通气超过一天的患者进行评估。根据年龄和损伤严重程度评分，对70例发生VAP的患者和70例未发生VAP的患者进行匹配。使用Kruskal-Wallis检验和两样本t检验比较差异。p < 0.05被认为具有统计学意义。
发生VAP的病例对照患者（82,195美元）与未发生VAP的患者（25,037美元）之间的ICU费用差异具有统计学意义（p < 0.05）。ICU住院时间（21.6天对6.4天）和呼吸机使用天数（17.7天对5.8天；两者均p < 0.05）也显著增加。病例对照人群中的死亡率没有差异。VAP增加的费用很大一部分来自ICU住院时间的延长（每天1861美元）。在分析费用分布时，药房、呼吸科和“其他”方面的费用也有所增加。这意味着每100例ICU入院患者可避免约428,685美元的费用。
呼吸机相关性肺炎不仅会导致呼吸机使用天数和ICU住院时间显著增加，还会大幅增加医院成本。在我们的ICU中，每发生一次VAP的费用为57,000美元。
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