Faraoni David, Nasr Viviane G, DiNardo James A, Thiagarajan Ravi R
Department of Anesthesiology, Peri-operative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Department of Anesthesiology, Peri-operative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
J Pediatr. 2016 Feb;169:69-75.e1. doi: 10.1016/j.jpeds.2015.10.002. Epub 2015 Nov 5.
To assess the characteristics associated with high hospital cost for patients receiving extracorporeal membrane oxygenation (ECMO) to identify a cohort of high-resource users.
Cost for hospitalization, during which ECMO support was used, was calculated from hospital charges reported in the 2012 Health Care Cost and Use Project Kid's Inpatient Database. Patients were categorized into 6 diagnostic groups: (1) cardiac surgery; (2) nonsurgical heart disease; (3) congenital diaphragmatic hernia; (4) neonatal respiratory failure; (5) pediatric respiratory failure; and (6) sepsis. We categorized cost into 4 groups based on quartiles. We compared ECMO cost with hospital cost for bone marrow, liver, and kidney transplants performed during the same year.
Median hospital cost for children supported with ECMO (n = 1465) was $230,425 (IQR: $126,599-$420,960). In a multivariable model, lower cost was associated with neonatal respiratory failure (OR: 0.19) and sepsis (OR 0.53) compared with cardiac surgery (OR: 1.88), whereas greater cost was associated with smaller hospital bed-size <99 (OR: 3.49) and 100-399 beds (OR: 3.03) compared with hospitals >400 beds, hospital location (Midwest [OR: 1.74] and West [OR 2.18] compared with North-East), and complications such as renal failure (OR: 3.77) and thromboembolic complications (OR 1.60). Hospital cost per survivor was greater for ECMO ($519,450) than bone marrow transplantation ($207,212), liver ($231,755), or kidney transplantation ($82,008) groups.
Hospitalization cost for children supported with ECMO is high. Diagnosis, hospital characteristics, and presence of complications are associated with increased cost.
评估接受体外膜肺氧合（ECMO）治疗的患者中与高住院费用相关的特征，以确定高资源使用人群。
根据2012年医疗保健成本与使用项目儿童住院数据库中报告的医院收费，计算使用ECMO支持期间的住院费用。患者被分为6个诊断组：（1）心脏手术；（2）非手术性心脏病；（3）先天性膈疝；（4）新生儿呼吸衰竭；（5）小儿呼吸衰竭；（6）脓毒症。我们根据四分位数将费用分为4组。我们将ECMO费用与同年进行的骨髓、肝脏和肾脏移植的医院费用进行了比较。
接受ECMO治疗的儿童（n = 1465）的住院费用中位数为230,425美元（四分位距：126,599 - 420,960美元）。在多变量模型中，与心脏手术（比值比：1.88）相比，新生儿呼吸衰竭（比值比：0.19）和脓毒症（比值比0.53）的费用较低，而与床位大于400张的医院相比，床位规模较小的医院（小于99张床位[比值比：3.49]和100 - 399张床位[比值比：3.03]）、医院位置（与东北部相比，中西部[比值比：1.74]和西部[比值比2.18]）以及肾衰竭（比值比：3.77）和血栓栓塞并发症（比值比1.60）等并发症的费用较高。ECMO组每位幸存者的住院费用（519,450美元）高于骨髓移植组（207,212美元）、肝脏移植组（231,755美元）或肾脏移植组（82,008美元）。
接受ECMO治疗的儿童住院费用很高。诊断、医院特征和并发症的存在与费用增加有关。
