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Cost comparison of mechanically ventilated patients across the age span

Journal of Perinatology volume 35, pages 1020–1026 (2015)Cite this article

Subjects

Abstract

Objective:

To compare the use of mechanical ventilation and hospital costs across ventilated patients of all ages, preterm through adults, in a nationally representative sample.

Study Design:

Secondary analysis of the 2009 Agency for Healthcare Research and Quality National Inpatient Sample.

Results:

A total of 1 107 563 (2.8%) patients received mechanical ventilation. For surviving ventilated patients, median costs for infants ⩽32 weeks’ gestation were $51000 to $209 000, whereas median costs for older patients were lower from $17 000 to $25 000. For non-surviving ventilated patients, median costs were $27 000 to $39 000 except at the extremes of age; the median cost was $10 000 for <24 week newborns and $14 000 for 91+ year adults. Newborns of all gestational ages had a disproportionate share of hospital costs relative to their total volume.

Conclusion:

Most intensive care unit resources at the extremes of age are not directed toward non-surviving patients. From a perinatal perspective, attention should be directed toward improving outcomes and reducing costs for all infants, not just at the earliest gestational ages.

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References

  1. Halpern NA, Pastores SM, Greenstein RJ . Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs. Crit Care Med 2004; 32 (6): 1254–1259.

    Article  Google Scholar 

  2. Halpern NA, Pastores SM . Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med 2010; 38 (1): 65–71.

    Article  Google Scholar 

  3. Wightman A, Largent E, Del Beccaro M, Lantos JD . Who should get the last PICU bed? Pediatrics 2014; 133 (5): 907–912.

    Article  Google Scholar 

  4. Wunsch H, Wagner J, Herlim M, Chong DH, Kramer AA, Halpern SD . ICU occupancy and mechanical ventilator use in the United States. Crit Care Med 2013; 41 (12): 2712–2719.

    Article  Google Scholar 

  5. Kissoon N, Burns J . Who should pediatric intensive care when not all can? A call for international guidelines on allocation of pediatric intensive care resources. Pediatr Crit Care Med 2014; 15 (1): 82–83.

    Article  Google Scholar 

  6. Kahn JM, Angus DC . Reducing the cost of critical care: new challenges, new solutions. Am J Respir Crit Care Med 2006; 174 (11): 1167–1168.

    Article  Google Scholar 

  7. Young MJ, Brown SE, Truog RD, Halpern SD . Rationing in the intensive care unit: to disclose or disguise? Crit Care Med 2012; 40 (1): 261–266.

    Article  Google Scholar 

  8. Leuthner SR . Borderline viability: controversies in caring for the extremely premature infant. Clin Perinatol 2014; 41 (4): 799–814.

    Article  Google Scholar 

  9. Lantos JD, Mokalla M, Meadow W . Resource allocation in neonatal and medical ICUs. Am J Respir Crit Care Med 1997; 156 (1): 185–189.

    Article  CAS  Google Scholar 

  10. Webb MS, Passmore D, Cline G, Maguire D . Ethical issues related to caring for low birth weight infants. Nurs Ethics 2014; 21 (6): 731–741.

    Article  Google Scholar 

  11. Meadow W, Lantos JD, Mokalla M, Reimshisel T . Distributive justice across generations. Epidemiology of ICU care for the very young and the very old. Clin Perinatol 1996; 23 (3): 597–608.

    Article  CAS  Google Scholar 

  12. Vanhaesebrouck P, Allegaert K, Bottu J, Debauche C, Devlieger H, Docx M et al. The EPIBEL study: outcomes to discharge from hospital for extremely preterm infants in Belgium. Pediatrics 2004; 114 (3): 663–675.

    Article  Google Scholar 

  13. Partridge JC, Robertson KR, Rogers EE, Landman GO, Allen AJ, Caughey AB . Resuscitation of neonates at 23 weeks’ gestational age: a cost-effectiveness analysis. J Matern Fetal Neonatal Med 2015; 28 (2): 121–130.

    Article  Google Scholar 

  14. Janvier A, Bauer KL, Lantos JD . Are newborns morally different from older children? Theor Med Bioeth 2007; 28 (5): 413–425.

    Article  Google Scholar 

  15. Welton JM, Meyer AA, Mandelkehr L, Fakhry SM, Jarr S . Outcomes of and resource consumption by high-cost patients in the intensive care unit. Am J Crit Care 2002; 11 (5): 467–473.

    PubMed  Google Scholar 

  16. Lane SD, Rubinstein RA, Cibula D, Webster N . Towards a public health approach to bioethics. Ann NY Acad Sci 2000; 925: 25–36.

    Article  CAS  Google Scholar 

  17. Van Reempts PJ, Van Acker KJ . Ethical aspects of cardiopulmonary resuscitation in premature neonates: where do we stand? Resuscitation 2001; 51 (3): 225–232.

    Article  CAS  Google Scholar 

  18. Pasaron R . Neonatal bioethical perspectives: practice considerations. Neonatal Netw 2013; 32 (3): 184–192.

    Article  Google Scholar 

  19. Soll RF, Edwards EM, Badger GJ, Kenny MJ, Morrow KA, Buzas JS et al. Obstetric and neonatal care practices for infants 501 to 1500 g from 2000 to 2009. Pediatrics 2013; 132 (2): 222–228.

    Article  Google Scholar 

  20. Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Penuelas O, Abraira V et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013; 188 (2): 220–230.

    Article  Google Scholar 

  21. Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E et al. Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest 2011; 140 (5): 1223–1231.

    Article  Google Scholar 

  22. Critical Care Societies Collaborative - Critical Care: Five Things Physicians and Patients Should Question (3 March 2015). Available from http://www.choosingwisely.org/doctor-patient-lists/critical-care-societies-collaborative-critical-care/.

  23. National Inpatient Sample Overview (23 April 2015). Available from https://www.hcup-us.ahrq.gov/nisoverview.jsp.

  24. Hagen EM, Therkelsen OB, Forde R, Aasland O, Janvier A, Hansen TW . Challenges in reconciling best interest and parental exercise of autonomy in pediatric life-or-death situations. J Pediatr 2012; 161 (1): 146–151.

    Article  Google Scholar 

  25. Janvier A, Leblanc I, Barrington KJ . The best-interest standard is not applied for neonatal resuscitation decisions. Pediatrics 2008; 121 (5): 963–969.

    Article  Google Scholar 

  26. Armstrong K, Ryan CA, Hawkes CP, Janvier A, Dempsey EM . Life and death decisions for incompetent patients: determining best interests—the Irish perspective. Acta Paediatr 2011; 100 (4): 519–523.

    Article  CAS  Google Scholar 

  27. Laventhal N, Spelke MB, Andrews B, Larkin LK, Meadow W, Janvier A . Ethics of resuscitation at different stages of life: a survey of perinatal physicians. Pediatrics 2011; 127 (5): 2010–1031.

    Article  Google Scholar 

  28. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3): 443–456.

    Article  Google Scholar 

  29. Lantos JD, Meadow WL . Costs and end-of-life care in the NICU: lessons for the MICU? J Law Med Ethics 2011; 39 (2): 194–200.

    Article  Google Scholar 

  30. Lagatta JM, Clark RH, Brousseau DC, Hoffmann RG, Spitzer AR . Varying patterns of home oxygen use in infants at 23-43 weeks' gestation discharged from United States neonatal intensive care units. J Pediatr 2013; 163 (4): 976–982, e2.

    Article  Google Scholar 

  31. Lorch SA, Srinivasan L, Escobar GJ . Epidemiology of apnea and bradycardia resolution in premature infants. Pediatrics 2011; 128 (2): e366–e373.

    Article  Google Scholar 

  32. Silber JH, Lorch SA, Rosenbaum PR, Medoff-Cooper B, Bakewell-Sachs S, Millman A et al. Time to send the preemie home? Additional maturity at discharge and subsequent health care costs and outcomes. Health Serv Res 2009; 44 (2 Pt 1): 444–463.

    Article  Google Scholar 

  33. Lagatta J, Clark R, Spitzer A . Clinical predictors and institutional variation in home oxygen use in preterm infants. J Pediatr 2012; 160 (2): 232–238.

    Article  Google Scholar 

  34. Janvier A, Mercurio MR . Saving vs creating: perceptions of intensive care at different ages and the potential for injustice. J Perinatol 2013; 33 (5): 333–335.

    Article  Google Scholar 

  35. Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC . The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003; 167 (5): 695–701.

    Article  Google Scholar 

  36. Report from the Congenital Diaphragmatic Hernia Study Group Registry (23 April 2015). Available from https://med.uth.edu/pediatricsurgery/research/research-centers-and-programs/cdhsg/.

  37. Timmons OD, Havens PL, Fackler JC . Predicting death in pediatric patients with acute respiratory failure. Pediatric Critical Care Study Group. Extracorporeal Life Support Organization. Chest 1995; 108 (3): 789–797.

    Article  CAS  Google Scholar 

  38. Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J et al. Special Report - Neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics 2010; 126 (5): e1400–e1413.

    Article  Google Scholar 

  39. Rysavy MA, Li L, Bell EF, Das A, Hintz SR, Stoll BJ et al. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015; 372 (19): 1801–1811.

    Article  Google Scholar 

  40. Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364 (14): 1293–1304.

    Article  CAS  Google Scholar 

  41. Pratt CM, Hirshberg EL, Jones JP, Kuttler KG, Lanspa MJ, Wilson EL et al. Long-term outcomes after severe shock. Shock 2015; 43 (2): 128–132.

    Article  Google Scholar 

  42. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med 2012; 40 (2): 502–509.

    Article  Google Scholar 

Download references

Acknowledgements

This study was partially supported by the National Center for Advancing Translational Sciences, National Institutes of Health through Grant Number 8UL1TR000055. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA

    W R Hayman

  2. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

    S R Leuthner, D C Brousseau & J M Lagatta

  3. Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA

    N T Laventhal

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  1. W R Hayman
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  2. S R Leuthner
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  3. N T Laventhal
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  4. D C Brousseau
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Correspondence to J M Lagatta.

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Hayman, W., Leuthner, S., Laventhal, N. et al. Cost comparison of mechanically ventilated patients across the age span. J Perinatol 35, 1020–1026 (2015). https://doi.org/10.1038/jp.2015.131

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