The Epidemiology of Respiratory Failure in the United States 2002-2017: A Serial Cross-Sectional Study.

OBJECTIVES

Respiratory failure with mechanical ventilation is a limited labor-intensive resource that is associated with high mortality. Understanding the longitudinal national epidemiology is essential for the organization of healthcare resources.

DESIGN

Serial cross-sectional study.

SETTING

The 2002-2017 Healthcare Utilization Project's National Inpatient Sample datasets.

INTERVENTIONS

None.

MEASUREMENTS

We use six diagnosis codes and five procedural codes from , 9th Revision, Clinical Modification, and 19 diagnosis codes and 15 procedures codes from , 10th Revision, Clinical Modification to examine national epidemiology of different case definitions for respiratory failure.

RESULTS

In the United States in 2017, there were an estimated 1,146,195 discharges with a diagnosis of respiratory failure and procedural code for mechanical ventilation, with an average length of stay of 10.5 days and hospital charge of $158,443. Over the study period, there was an 83% increase in incidence from 249 to 455 cases per 100,000 adults with a 48% decrease in hospital mortality from 34% to 23%. Exploring a case definition that captures only diagnosis codes for respiratory failure, there was a 197% increase in annual incidence, from 429 to 1,275 cases per 100,000 adults with a 57% decrease in hospital mortality from 28% to 12%. For invasive mechanical ventilation without a requisite diagnosis code, there was no change in incidence over the study period, with the 2017 incidence at 359 cases per 100,000 adults, but a 19% decrease in hospital mortality from 37% to 30%. For the noninvasive mechanical ventilation procedural codes, there was a 437% increase in incidence from 41 to 220 cases per 100,000 adults, with a 38% decrease in hospital mortality from 16% to 10%.

CONCLUSIONS

Examining different case definitions for respiratory failure, there was a large increase in the population incidence and decrease in the hospital mortality for respiratory failure diagnosis codes with more modest changes procedural codes for invasive mechanical ventilation. There was a large increase in incidence of noninvasive mechanical ventilation.