Washington University School of Medicine, St. Louis, MO 63110, USA.
Infect Control Hosp Epidemiol. 2012 Mar;33(3):250-6. doi: 10.1086/664049. Epub 2012 Jan 17.
To evaluate the economic impact of ventilator-associated pneumonia (VAP) on length of stay and hospital costs. Design. Retrospective matched cohort study.
Premier database of hospitals in the United States.
Eligible patients were admitted to intensive care units (ICUs), received mechanical ventilation for ≥2 calendar-days, and were discharged between October 1, 2008, and December 31, 2009.
VAP was defined by International Classification of Diseases, Ninth Revision (ICD-9), code 997.31 and ventilation charges for ≥2 calendar-days. We matched patients with VAP to patients without VAP by propensity score on the basis of demographics, administrative data, and severity of illness. Cost was based on provider perspective and procedural cost accounting methods.
Of 88,689 eligible patients, 2,238 (2.5%) had VAP; the incidence rate was 1.27 per 1,000 ventilation-days. In the matched cohort, patients with VAP ([Formula: see text]) had longer mean durations of mechanical ventilation (21.8 vs 10.3 days), ICU stay (20.5 vs 11.6 days), and hospitalization (32.6 vs 19.5 days; all [Formula: see text]) than patients without VAP ([Formula: see text]). Mean hospitalization costs were $99,598 for patients with VAP and $59,770 for patients without VAP ([Formula: see text]), resulting in an absolute difference of $39,828. Patients with VAP had a lower in-hospital mortality rate than patients without VAP (482/2,144 [22.5%] vs 630/2,144 [29.4%]; [Formula: see text]).
Our findings suggest that VAP continues to occur as defined by the new specific ICD-9 code and is associated with a statistically significant resource utilization burden, which underscores the need for cost-effective interventions to minimize the occurrence of this complication.
评估呼吸机相关性肺炎（VAP）对住院时间和医院费用的经济影响。设计：回顾性匹配队列研究。
美国医院的首要数据库。
符合条件的患者入住重症监护病房（ICU），接受机械通气≥2个日历日，并于 2008 年 10 月 1 日至 2009 年 12 月 31 日出院。
VAP 通过国际疾病分类，第九版（ICD-9）代码 997.31 和通气≥2个日历日的费用来定义。我们根据人口统计学、行政数据和疾病严重程度，通过倾向评分对 VAP 患者和无 VAP 患者进行匹配。成本基于提供者视角和程序成本核算方法。
在 88689 名符合条件的患者中，2238 名（2.5%）患有 VAP；发病率为每 1000 通气日 1.27 例。在匹配队列中，VAP 患者（[公式：见正文]）的机械通气时间（21.8 天比 10.3 天）、ICU 入住时间（20.5 天比 11.6 天）和住院时间（32.6 天比 19.5 天；均[公式：见正文]）长于无 VAP 患者。VAP 患者的住院费用为 99598 美元，无 VAP 患者为 59770 美元（[公式：见正文]），差异为 39828 美元。VAP 患者的院内死亡率低于无 VAP 患者（482/2144[22.5%]比 630/2144[29.4%]；[公式：见正文]）。
我们的研究结果表明，按照新的特定 ICD-9 编码，VAP 仍在持续发生，并且与统计学上显著的资源利用负担相关，这突出表明需要采取具有成本效益的干预措施来最大限度地减少这种并发症的发生。
