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Abstract

Introduction: Perioperative respiratory failure (PRF), is a major cause of nosocomial morbidity and mortality. It also consumes intense healthcare resources having been estimated to impose incremental costs in the tens of thousands of dollars to the cost of hospitalization. Hypothesis: We hypothesized that with changes in healthcare delivery, the median and extremal incremental hospital charges attributable to PRF, have changed over time. Furthermore, we hypothesized that the proportion of patients with a routine discharge to home, would decrease over time and that the daily hospital charges would increase. Methods: Approximately 28 million inpatient discharges between 2003 and 2009 were analyzed from the California State Inpatient Database. PRF was defined using ICD-9-CM codes. Propensity matching of a PRF patient to a control patient to account for potential confounding – yielded 74,026 matched pairs for the analysis. A quantile regression model was used with incremental charges as the response variable and year of discharge as the main predictor to evaluate the incremental charges over time. Model based Wald tests were used to perform the tests of trends over time. All charges were adjusted to a base year of 2012 using the medical component of the consumer price index. Results: Results showed that the median incremental charges changed annually by -$3770 (95% CI; -$4630, -$2920). The highest 10% of costs declined significantly by -$14,110 annually (95% CI; -$17,820, -$10,410). The bottom 10% of charges did not significantly change with time. Compared to control patients, relative odds of routine discharge was stable over time at 0.4 times that of patients without PRF. The odds of transfer and discharge to home health care decreased only slightly with time. No linear trends in daily charges were statistically significant. Conclusions: In conclusion, insofar as charges reflect costs, this study suggests modest progress in cost control in the management of perioperative respiratory failure. If further study confirms that this trend holds true in other regions, it would be encouraging sign for the overall struggle to control the inexorable rise in health care costs.