ICU Costs Research Articles

Epidemiological profile trends and cost of pediatric sickle cell disease in Brazil from 2008 to 2022

ObjectiveThis study aimed to investigate the epidemiological trends of Pediatric Sickle Cell Disease (SCD) in Brazil over the period 2008–2022, with a focus on understanding the incidence, mortality rates, and associated healthcare costs. The study explored potential associations between patient characteristics and the occurrence of crises in pediatric SCD cases. MethodsA cross-sectional study was conducted, analyzing national annual rates of pediatric SCD hospitalizations using data from the FioCruz platform. Descriptive and inferential analyses, including time series and ARIMA regression, were employed. Economic dimensions were assessed using cost categorization. The study followed STROBE reporting guidelines. ResultsData on 81,942 pediatric SCD hospitalizations were collected, with a predominance of crisis-related cases (74.08 %). Males and children under five years old were most affected. Regional disparities were observed, with the Southwest region recording the highest hospitalization rates. ICU costs were higher for crisis-related hospitalizations. Mortality rates were significantly higher for crisis-related cases (p < 0.001), with ARIMA regression indicating a significant association between hospitalizations for crisis-related cases and mortality. ConclusionThis study highlights the significant burden of pediatric SCD in Brazil, particularly crisis-related cases, suggesting a need for focused interventions. By prioritizing early detection, equitable access to healthcare, and evidence-based interventions, Brazil can mitigate the burden of SCD and improve patient outcomes. These findings contribute to informing public health policies and interventions aimed at addressing the challenges of pediatric SCD management in Brazil.

Actual Cost of Extracorporeal Cardiopulmonary Resuscitation: A Time-Driven Activity-Based Costing Study.

To determine the actual cost and drivers of the cost of an extracorporeal cardiopulmonary resuscitation (E-CPR) care cycle. A time-driven activity-based costing study conducted from a healthcare provider perspective. A quaternary care ICU providing around-the-clock E-CPR service for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in Australia. The E-CPR care cycle was defined as the time from initiating E-CPR to hospital discharge or death of the patient. Detailed process maps with discrete steps and probabilistic decision nodes accounting for the complex trajectories of E-CPR patients were developed. Data about clinical and nonclinical resources and timing of activities was collected multiple times for each process . Total direct costs were calculated using the time estimates and unit costs per resource for all clinical and nonclinical resources. The total direct costs were combined with indirect costs to obtain the total cost of E-CPR. From 10 E-CPR care cycles observed during the study period, a minimum of 3 observations were obtained per process. The E-CPR care cycle's mean (95% CI) cost was $75,014 ($66,209-83,222). Initiation of extracorporeal membrane oxygenation (ECMO) and ECMO management constituted 18% of costs. The ICU management (35%) and surgical costs (20%) were the primary cost determinants. IHCA had a higher mean (95% CI) cost than OHCA ($87,940 [75,372-100,570] vs. 62,595 [53,994-71,890], p < 0.01), mainly because of the increased survival and ICU length of stay of patients with IHCA. The mean cost for each E-CPR survivor was $129,503 ($112,422-147,224). Significant costs are associated with E-CPR for refractory cardiac arrest. The cost of E-CPR for IHCA was higher compared with the cost of E-CPR for OHCA. The major determinants of the E-CPR costs were ICU and surgical costs. These data can inform the cost-effectiveness analysis of E-CPR in the future.

The clinical value of mNGS of bronchoalveolar lavage fluid versus traditional microbiological tests for pathogen identification and prognosis of severe pneumonia (NT-BALF):study protocol for a prospective multi-center randomized clinical trial.

Early, rapid, and accurate pathogen diagnosis can help clinicians select targeted treatment options, thus improving prognosis and reducing mortality rates of severe pneumonia. Metagenomic next-generation sequencing (mNGS) has a higher sensitivity and broader pathogen spectrum than traditional microbiological tests. However, the effects of mNGS-based antimicrobial treatment procedures on clinical outcomes and cost-effectiveness in patients with severe pneumonia have not been evaluated. This is a regional, multi-center, open, prospective, randomized controlled trial to evaluate that whether the combination of mNGS and traditional testing methods could decrease 28-day call-cause mortality with moderate cost-effectiveness. A total of 192 patients with severe pneumonia will be recruited from four large tertiary hospitals in China. Bronchoalveolar lavage fluid will be obtained in all patients and randomly assigned to the study group (mNGS combined with traditional microbiological tests) or the control group (traditional microbiological tests only) in a 1:1 ratio. Individualized antimicrobial treatment and strategy will be selected according to the analysis results. The primary outcome is 28-day all-cause mortality. The secondary outcomes are ICU and hospital length of stay (LOS), ventilator-free days and ICU-free days, consistency between mNGS and traditional microbiological tests, detective rate of mNGS and traditional microbiological tests, turn-out time, time from group allocation to start of treatment, duration of vasopressor support, types and duration of anti-infective regimens, source of drug-resistant bacteria or fungi, and ICU cost. The clinical benefits of mNGS are potentially significant, but its limitations should also be considered. ChineseClinicalTrialRegistry.org, ChiCTR2300076853. Registered on 22 October 2023.

Disease Burden and Inpatient Management of Children with Acute Respiratory Viral Infections during the Pre-COVID Era in Germany: A Cost-of-Illness Study.

Respiratory viral infections (RVIs) are common reasons for healthcare consultations. The inpatient management of RVIs consumes significant resources. From 2009 to 2014, we assessed the costs of RVI management in 4776 hospitalized children aged 0-18 years participating in a quality improvement program, where all ILI patients underwent virologic testing at the National Reference Centre followed by detailed recording of their clinical course. The direct (medical or non-medical) and indirect costs of inpatient management outside the ICU ('non-ICU') versus management requiring ICU care ('ICU') added up to EUR 2767.14 (non-ICU) vs. EUR 29,941.71 (ICU) for influenza, EUR 2713.14 (non-ICU) vs. EUR 16,951.06 (ICU) for RSV infections, and EUR 2767.33 (non-ICU) vs. EUR 14,394.02 (ICU) for human rhinovirus (hRV) infections, respectively. Non-ICU inpatient costs were similar for all eight RVIs studied: influenza, RSV, hRV, adenovirus (hAdV), metapneumovirus (hMPV), parainfluenza virus (hPIV), bocavirus (hBoV), and seasonal coronavirus (hCoV) infections. ICU costs for influenza, however, exceeded all other RVIs. At the time of the study, influenza was the only RVI with antiviral treatment options available for children, but only 9.8% of influenza patients (non-ICU) and 1.5% of ICU patients with influenza received antivirals; only 2.9% were vaccinated. Future studies should investigate the economic impact of treatment and prevention of influenza, COVID-19, and RSV post vaccine introduction.

The continued financial effect of COVID: Increasing costs for non-elective major lower extremity amputations

BackgroundThe COVID-19 pandemic necessitated changes in processes of care, which significantly impacted surgical care. This study evaluated the impact of these changes on patient outcomes and costs for non-elective major lower extremity amputations (LEA). MethodsThe 2019–2021 Florida Agency for Health Care Administration database was queried for adult patients who underwent non-elective major LEA. Per-patient inflation-adjusted costs were collected. Patient cohorts were established based on Florida COVID-19 mortality rates: COVID-heavy (CH) included nine months with the highest mortality, COVID-light (CL) included nine months with the lowest mortality, and pre-COVID (PC) included nine months before COVID (2019). Outcomes included in-hospital patient outcomes and hospitalization cost. Results6132 patients were included (1957 PC, 2104 CH, and 2071 CL). Compared to PC, there was increased patient acuity at presentation, but morbidity (31%), mortality (4%), and length of stay (median 12 [8–17] days) were unchanged during CH and CL. Additionally, costs significantly increased during the pandemic; median total cost rose 9%, room costs increased by 16%, ICU costs rose by 15%, and operating room costs rose by 15%. When COVID-positive patients were excluded, cost of care was still significantly higher during CH and CL. ConclusionsDespite maintaining pre-pandemic standards, as evidenced by unchanged outcomes, the pandemic led to increased costs for patients undergoing non-elective major LEA. This was likely due to increased patient acuity, resource strain, and supply chain shortages during the pandemic. Key messageWhile patient outcomes for non-elective major lower extremity amputations remained consistent during the COVID-19 pandemic, healthcare costs significantly increased, likely due to increased patient acuity and heightened pressures on resources and supply chains. These findings underscore the need for informed policy changes to mitigate the financial impact on patients and healthcare systems for future public health emergencies.

Development of a Variable Cost Prediction Model for Hospitalized Critically Ill Patients in ICU

Introduction: Hospitalization of critically ill patients in the ICU is one of the most expensive areas of hospital care. Aim: The creation of a variable cost prediction model for hospitalized patients in ICU. Material and method: A retrospective observational study was carried out, using the bottom-up costing methodology. The study sample consisted of 204 hospitalized patients in the 7-bed ICU of 251 AGH, from January 1, 2016 to December 31, 2017. The demographic and clinical characteristics of the patients were recorded and the variable cost of hospitalization was accurately calculated, through an analytical recording of all the resources required for their treatment. Multivariable linear regression was implemented to investigate the impact of variables, derived from a systematic review conducted on determinants of intensive care costs. Gender, age, length of stay, APACHE II severity scale, type of patient (medical/surgical), and renal replacement therapy were used as independent variables. The average total daily cost of hospitalisation and the average daily costs of laboratory tests, medication, and consumables were used as dependent variables. Results: An increase in APACHE II by one unit and length of ICU stay by one day is associated with an increase in total daily cost by 2.74% and 1.82% respectively, while an increase in age by one year with a decrease of 0.4 %. A medical patient shows 11.62% higher total daily cost than a surgical patient, while renal replacement therapy increases the cost by 79.49%. Conclusions:Variable ICU cost is related to gender, age, severity scale,type of event and need for renal replacement therapy.

Cost of in-patient management of COVID-19 patients in a general hospital in Kuwait

BackgroundAmong the GCC countries affected by COVID-19 infections, Kuwait has been significantly impacted, with 658,520 cases and 2,563 deaths reported by the WHO on September 30, 2022. However, the impact of the COVID-19 epidemic on Kuwait’s economy, especially in the healthcare sector, remains unknown. Objective: This study aims to determine the total cost of managing COVID-19 in-patients in Kuwait.MethodA cross-sectional design was employed for this study. A total of 485 COVID-19 patients admitted to a general hospital responsible for COVID-19 cases management were randomly selected for this study from May 1st to September 31st, 2021. Data on sociodemographic information, length of stay (LOS), discharge status, and comorbidities were obtained from the patients’ medical records. The data on costs in this study cover administration, utility, pharmacy, radiology, laboratory, nursing, and ICU costs. The unit cost per admission was calculated using a step-down costing method with three levels of cost centers. The unit cost was then multiplied by the individual patient’s length of stay to determine the cost of care per patient per admission.FindingsThe mean cost of COVID-19 in-patient care per admission was KD 2,216 (SD = 2,018), which is equivalent to USD 7,344 (SD = 6,688), with an average length of stay of 9.4 (SD = 8.5) days per admission. The total treatment costs for COVID-19 in-patients (n = 485) were estimated to be KD 1,074,644 (USD 3,561,585), with physician and nursing care costs constituting the largest share at 42.1%, amounting to KD 452,154 (USD 1,498,529). The second and third-largest costs were intensive care (20.6%) at KD 221,439 (USD 733,893) and laboratory costs (10.2%) at KD 109,264 (USD 362,123). The average cost for severe COVID-19 patients was KD 4,626 (USD 15,332), which is almost three times higher than non-severe patients of KD 1,544 (USD 5,117).ConclusionManaging COVID-19 cases comes with substantial costs. This cost information can assist hospital managers and policymakers in designing more efficient interventions, especially for managing high-risk groups.

Cost Analysis of the Acute Spinal Cord Injury Ward and ICU Costs at a Tertiary Hospital in South Africa: What Is the Cost Per Patient Per Day?

Cost Analysis of the Acute Spinal Cord Injury Ward and ICU Costs at a Tertiary Hospital in South Africa: What Is the Cost Per Patient Per Day?

Cost-effectiveness of terlipressin for hepatorenal syndrome: the United States hospital perspective

BackgroundHepatorenal syndrome (HRS) is characterized by severely reduced renal perfusion that precipitates rapid morbidity and mortality. Terlipressin is the only US Food and Drug Administration-approved treatment to improve kidney function for adults with HRS with a rapid reduction in kidney function. Prior to the approval of terlipressin, unapproved vasoconstrictive agents used in HRS treatment were octreotide/midodrine and norepinephrine with albumin.MethodsA cohort decision-tree model representing a US hospital perspective assessed the clinical outcomes and direct medical costs (based primarily on hospital charges) of treating HRS with terlipressin + albumin (ALB) versus midodrine/octreotide (MID/OCT)+ALB, or norepinephrine (NorEp)+ALB. Treatment efficacy was defined by clinical response (complete/HRS reversal, partial, or no response) based on change of serum creatinine derived from published clinical trial reports. The proportions of patients with complete response were: terlipressin + ALB (36.2%), NorEp + ALB (19.1%), and MID/OCT + ALB (3.1%). Model outcomes included utilization of HRS-related healthcare resources (hospital and intensive care, outpatient and emergency department, dialysis, and transplantations), adverse events, and HRS-related mortality. Outcomes were assessed for the initial hospitalization in the base case and at 30, 60, and 90 days post-discharge.ResultsTotal costs incurred over the initial hospitalization with terlipressin + ALB were lower vs NorEp + ALB, primarily due to higher ICU costs with NorEp + ALB ($7,433 vs $61,897). TER + ALB was associated with higher total costs vs MID/OCT + ALB due to higher pharmacy costs with terlipressin + ALB. The cost per complete response achieved of terlipressin + ALB ($451,605) was half that of NorEp + ALB ($930,571) and one-tenth that of MID/OCT + ALB ($4,942,123).ConclusionsHRS patients treated with terlipressin experienced better clinical outcomes and a lower cost per treatment response vs other unapproved treatments. ICU days and pharmacy costs were key cost drivers distinguishing the treatment groups. These outcomes suggest that terlipressin is cost-effective on the basis of total cost per response achieved.

A single-patient-use ECG system for cardiothoracic surgery admissions in the UK: A cost-consequence analysis.

Deep sternal wound infections (DSWI) are severe complications in up to 1.36% of coronary artery bypass grafting (CABG) procedures in the United Kingdom. Each event adds between £4,000 and £11,000 in healthcare costs, owing primarily to prolonged hospitalisations. ECG devices have been shown to convey infection throughout perioperative CABG. On the other hand, single-patient ECG devices (spECG) can effectively reduce the incidence of surgical site infections (SSI), including DSWI, but no assessment of spECG impact in NHS cardiac units has been conducted. To estimate the impact of spECG on NHS cardiac units, we conducted a cost-consequence analysis modeling the CABG care pathway in the United Kingdom using Simul8 software for a probabilistic, individual-patient simulation. The simulation time was 1 year, with each patient followed from admission through 30 days post-discharge. The base case simulation mirrors the cardiac unit of Bart Health NHS Trust, London. A total of 2,183 patients are generated with demographic and clinical attributes from probabilistic distributions informed by hospital-specific inputs from NHS Digital Data. The Brompton Harefield Infection Score (BHIS) is allocated to gauge the risk of SSI. Results are averaged across 50 independent and randomly seeded iterations. Simulation results indicate a base-case savings of £388 per patient, determined by the incidence of infections rather than the number of CABG procedures. In the base-case simulation, the mean cost of care with rECG was £13,096, whereas the mean cost with spECG was £12,708, resulting in a cost saving of £388 (2021 GBP). The simulation yielded an overall 8.6% SSI incidence rECG, whereas the incidence of SSIs with spECG was 6.9%. The model was most sensitive to changes in general ward and ICU costs, and infection incidence was a stronger predictor of potential per-patient savings than annual CABG volume. Single-patient ECG is a sustainable and effective alternative to reusable ECG cables and lead wires in terms of patient safety and resource allocation.

The Impact of Restrictive Transfusion Practices on Hemodynamically Stable Critically Ill Children Without Heart Disease: A Secondary Analysis of the Age of Blood in Children in the PICU Trial.

Guidelines recommend against RBC transfusion in hemodynamically stable (HDS) children without cardiac disease, if hemoglobin is greater than or equal to 7 g/dL. We sought to assess the clinical and economic impact of compliance with RBC transfusion guidelines. A nonprespecified secondary analysis of noncardiac, HDS patients in the randomized trial Age of Blood in Children (NCT01977547) in PICUs. Costs analyzed included ICU stay and physician fees. Stabilized inverse propensity for treatment weighting was used to create a cohort balanced with respect to potential confounding variables. Weighted regression models were fit to evaluate outcomes based on guideline compliance. Fifty international tertiary care centers. Critically ill children 3 days to 16 years old transfused RBCs at less than or equal to 7 days of ICU admission. Six-hundred eighty-seven subjects who met eligibility criteria were included in the analysis. Initial RBC transfusions administered when hemoglobin was less than 7 g/dL were considered "compliant" or "non-compliant" if hemoglobin was greater than or equal to 7 g/dL. Frequency of new or progressive multiple organ system dysfunction (NPMODS), ICU survival, and associated costs. The hypothesis was formulated after data collection but exposure groups were masked until completion of planned analyses. Forty-nine percent of patients (338/687) received a noncompliant initial transfusion. Weighted cohorts were balanced with respect to confounding variables (absolute standardized differences < 0.1). No differences were noted in NPMODS frequency (relative risk, 0.86; 95% CI, 0.61-1.22; p = 0.4). Patients receiving compliant transfusions had more ICU-free days (mean difference, 1.73; 95% CI, 0.57-2.88; p = 0.003). Compliance reduced mean costs in ICU by $38,845 U.S. dollars per patient (95% CI, $65,048-$12,641). Deferring transfusion until hemoglobin is less than 7 g/dL is not associated with increased organ dysfunction in this population but is independently associated with increased likelihood of live ICU discharge and lower ICU costs.

Health Care Resource Utilization and Costs of Persistent Severe Acute Kidney Injury (PS-AKI) Among Hospitalized Stage 2/3 AKI Patients.

Key Points Among hospitalized patients with stage 2/3 AKI, persistent severe acute kidney injury (PS-AKI) is associated with significantly longer length of stay (LOS) and higher costs during index hospitalization and 30 days postdischarge.Relative differences in LOS and costs for PS-AKI versus NPS-AKI were similar for intensive care (ICU) and non-ICU patients.Preventing PS-AKI among patients with stage 2/3 AKI may reduce hospital LOS and costs. Background Persistent severe acute kidney injury (PS-AKI) is associated with worse clinical outcomes, but there are no data on costs of PS-AKI. We compared costs and health care resource utilization for inpatients with PS-AKI versus not persistent severe AKI (NPS-AKI) overall and by ICU use. Methods This retrospective observational study included 126,528 adult US inpatients in the PINC AI Healthcare Database (PHD), discharged from January 1, 2017, to December 31, 2019, with KDIGO stage 2 or 3 AKI (by serum creatinine [SCr] criteria) during hospitalization, length of stay (LOS) ≥3 days, and ≥3 SCr measurements. Patients were categorized as PS-AKI (defined as stage 3 AKI lasting ≥3 days or with death within 3 days or stage 2/3 AKI (by SCr criteria) with dialysis within 3 days) or NPS-AKI. Generalized linear model regression compared LOS and costs during index hospitalization (total cohort) and 30 days postdischarge (survivors of index hospitalization), adjusted for patient, hospital, and clinical characteristics. Results Among 126,528 patients with stage 2/3 AKI, 30,916 developed PS-AKI. In adjusted models, compared with NPS-AKI, patients with PS-AKI had 32% longer total LOS (+3.3 days), 45% longer ICU LOS (+2.6 days), 46% higher total costs (+$13,143), 58% higher ICU costs (+$15,908), and during 30 days postdischarge 13% longer readmission LOS (+1.0 day), 22% higher readmission costs (+$4049), and 12% higher outpatient costs (+$206) (P&lt;0.005 for all). Relative LOS and cost differences for PS-AKI versus NPS-AKI were similar for ICU (n=57,947) and non-ICU (n=68,581) patients. Conclusions: Among hospitalized patients with stage 2/3 AKI, PS-AKI was associated with significantly longer LOS and higher costs during index hospitalization and 30 days postdischarge, overall, and in ICU and non-ICU patients. Preventing PS-AKI among patients with stage 2/3 AKI may reduce hospital LOS and costs.

Potential Influence of Advance Care Planning and Palliative Care Consultation on ICU Costs for Patients With Chronic and Serious Illness

Potential Influence of Advance Care Planning and Palliative Care Consultation on ICU Costs for Patients With Chronic and Serious Illness

Hospital Costs and Healthcare Resource Utilization (HRU) for Chimeric Antigen (CAR) T-Cell Therapy and Stem Cell Transplant (SCT) in Patients with Large B-Cell Lymphoma (LBCL) in the United States (US)

Introduction: The efficacy of CAR T-cell therapy is well-established. However, the comparative hospital system costs and HRU for CAR T-cell therapy and SCT are largely unknown or based on rough estimates of cost-charge ratios. This study describes and compares the actuarial hospital costs and HRU of CAR T-cell therapy, administered in authorized treatment centers, and SCT for the procedure, pre-procedure, and follow-up periods. Methods: Adult patients in the PINC AI™ Healthcare Database were included if they had an inpatient or outpatient visit between 01/01/ 2017-04/30/2021 with CAR T-cell infusion or SCT transfusion for treating LBCL (principal or secondary discharge ICD-10-CM diagnosis codes: C83.3x, C85.1x, C85.2x, C85.8x, C83.8x, and C83.9x). Patients were excluded if they 1) had ≥2 CAR T-cell and/or SCT infusions, or 2) the treating hospital did not have continuous data for the patients during the 365-day pre-procedure and 180-day follow-up periods. The inpatient or outpatient infusion visit was considered the index event. Based on the index procedure, patients were classified as being in a CAR T-cell, autologous SCT (auto-SCT), or allogenic (allo-SCT) group. Patient characteristics (pre-index through index) and treating hospital characteristics (index) were summarized. Heath resource utilization (HRU) and costs (2021 US dollars) for the index, pre-procedure, and follow-up periods were assessed and reported by procedure type. Results: A total of 852 patients (208 CAR T; 595 auto-SCT; 49 allo-SCT) were treated at 37 hospital systems across the US. The mean patient age was 60 years (SD=12; median=62; 39.6% ≥ 65 yrs). 38.6% of patients were female, and 76.8% were white. Healthcare coverage varied (commercial: 43.9%; Medicare:36.3%; Medicaid:11.6%; other: 8.2%). The most common comorbidities other than malignancy were diabetes (17.6%), chronic pulmonary disease (9.2%), and renal disease (6.6%). Key patient characteristics (age, sex, race, health coverage, comorbidity) were similar across procedure types (Table 1). There was no noticeable difference in treating hospitals' teaching status nor hospital size between CAR T-cell therapy and SCT cohorts. Most patients were treated at large (n=608; 71.4%), teaching (n=720; 84.5%) hospitals; 93.4% (n=796) received their procedures inpatient, with slightly more auto-SCT in the inpatient than CAR T-cell infusions (94.8% vs 89.9%; p=0.01). Total mean cost of index procedure was higher for CAR T-cell therapy than for SCT ($371,136 CAR T, $96,515 auto-SCT, $169,269 allo-SCT; p<0.001). However, the mean index non-pharmacy cost was lower for CAR T-cell therapy than SCT (mean $41,375 CAR T, $51,778 auto-SCT, $111,594 allo-SCT; p<0.001). Among inpatient-treated patients, the average length of stay (LOS) was shorter for CAR T-cell therapy than for auto-SCT or allo-SCT (mean [median]: 18[15] days CAR T; 21[20] days auto-SCT; 28[26] days allo-SCT; p<0.001). Total ICU cost was lower for CAR T-cell therapy than for allo-SCT (mean $86,755 CAR T, $86,497 auto-SCT, $191,980 allo-SCT; p<0.001). Details of the index procedure hospital costs and HRU outcomes for CAR T, auto-SCT, and allo-SCT are in Table 2. Assessment of other outcomes, including adverse events, costs and HRU during the pre- and post-index periods, and sensitivity analysis are ongoing. Conclusions: This study is the first to examine actuarial cost and HRU with most recent real-world use of CAR-T and SCT using the hospital system perspective. The total and pharmacy cost to hospital providers for the index procedure were higher for patients who received CAR T-cell therapy than for SCT patients. However, non-pharmacy cost incurred during index procedure was lower for CAR T-cell therapy. Shorter hospital stays for CAR T-cell therapy patients contributed to this cost differential. Even though CAR T-cell treated patients incurred higher upfront pharmacy costs to hospitals compared to SCT, there were non-pharmacy cost offsets and lower HRU burdens overall to hospital system. Results should be interpreted with caution because they may not reflect HRU and costs to hospitals not included in the PINC AI™ Healthcare Database. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Costs and Factors Associated with Hospitalizations Due to Severe Influenza in Catalonia (2017-2020).

This study aimed to estimate the cost and factors associated with severe hospitalized patients due to influenza in unvaccinated and vaccinated cases. The study had a cross-sectional design and included three influenza seasons in 16 sentinel hospitals in Catalonia, Spain. Data were collected from a surveillance system of influenza and other acute respiratory infections. Generalized linear models (GLM) were used to analyze mean costs stratified by comorbidities and pregnancy. Multivariate logistic models were used to analyze bacterial coinfection, multi-organ failure, acute respiratory distress syndrome, death and ICU admission by season and by vaccination status. Costs of ICU, hospitalization and total mean costs were analyzed using GLM, by season and by vaccination status. All models were adjusted for age and sex. A total of 2742 hospitalized cases were included in the analyses. Cases were mostly aged ≥ 60 years (70.17%), with recommended vaccination (86.14%) and unvaccinated (68.05%). The ICU admission level was statistically significant higher in unvaccinated compared to vaccinated cases. Costs of cases with more than or equal to two comorbidities (Diff = EUR - 1881.32), diabetes (Diff = EUR - 1953.21), chronic kidney disease (Diff = EUR - 2260.88), chronic cardiovascular disease (Diff = EUR - 1964.86), chronic liver disease (Diff = EUR - 3595.60), hospitalization (EUR 9419.42 vs. EUR 9055.45), and total mean costs (EUR 11,540.04 vs. 10,221.34) were statistically significant higher in unvaccinated compared to vaccinated patients. The influenza vaccine reduces the costs of hospitalization. There is a need to focus strategies in recommended vaccination groups.

Quantifying protocols for safe school activities.

By the peak of COVID-19 restrictions on April 8, 2020, up to 1.5 billion students across 188 countries were affected by the suspension of physical attendance in schools. Schools were among the first services to reopen as vaccination campaigns advanced. With the emergence of new variants and infection waves, the question now is to find safe protocols for the continuation of school activities. We need to understand how reliable these protocols are under different levels of vaccination coverage, as many countries have a meager fraction of their population vaccinated, including Uganda where the coverage is about 8%. We investigate the impact of face-to-face classes under different protocols and quantify the surplus number of infected individuals in a city. Using the infection transmission when schools were closed as a baseline, we assess the impact of physical school attendance in classrooms with poor air circulation. We find that (i) resuming school activities with people only wearing low-quality masks leads to a near fivefold city-wide increase in the number of cases even if all staff is vaccinated, (ii) resuming activities with students wearing good-quality masks and staff wearing N95s leads to about a threefold increase, (iii) combining high-quality masks and active monitoring, activities may be carried out safely even with low vaccination coverage. These results highlight the effectiveness of good mask-wearing. Compared to ICU costs, high-quality masks are inexpensive and can help curb the spreading. Classes can be carried out safely, provided the correct set of measures are implemented.

Estimated economic impact of implementing exclusive palliative care in an intensive care unit / Impacto económico estimado da implementação de cuidados paliativos exclusivos numa unidade de cuidados intensivos

Palliative care (PC) is a modality of care for patients with no possibility of cure for a disease or terminally ill. The objective of this care model is to provide integral care to the patient and their family, involving the multidisciplinary team in caring, in addition to pursuing strategies so that the interventions conducted promote comfort and well-being for those involved. This is a retrospective cross-sectional study in which the total expenses and per day of hospitalization with exams and medications of patients before and after being included in the PC protocol of the institution were evaluated. All patients who met the inclusion criteria in the PC protocol and were likely to change the therapeutic focus to exclusive PC, oncologic and non-oncologic, were included. The study proved to be extremely relevant in the quantitative comparison of costs in adult ICU before and after PC, showing a reduction regarding cost/day with exams and medications of 95% and 44% respectively, and mean hospital stay was reduced from 14 to 6 days. It is noteworthy that 16% of those patients did not die in the ICU environment, representing a possible humanization of care and improvement in the quality of visits and family interaction. The results of this study indicate a significant decrease in costs with the correct implementation of exclusive PC, supporting the need for introduction of protocols and earlier and more comprehensive insertion of patients in PC.

Identification and Prevention of Extubation Failure by Using an Automated Continuous Monitoring Alert Versus Standard Care.

Postextubation monitoring helps identify patients at risk of developing respiratory failure. This study aimed to evaluate the effect of our standard respiratory therapist (RT) assessment tool versus an automated continuous monitoring alert to initiate postextubation RT-driven care on the re-intubation rate. This was a single-center randomized clinical trial from March 2020 to September 2021 of adult subjects who received mechanical ventilation for > 24 h and underwent planned extubation in the ICU. The subjects were assigned to the standard RT assessment tool or an automated monitoring alert to identify the need for postextubation RT-driven care. The primary outcome was the need for re-intubation due to respiratory failure within 72 h. Secondary outcomes included re-intubation within 7 d, ICU and hospital lengths of stay, hospital mortality, ICU cost, and RT time associated with patient assessment and therapy provision. Of 234 randomized subjects, 32 were excluded from the primary analysis due to disruption in RT-driven care during the surge of patients with COVID-19, and 1 subject was excluded due to delay in the automated monitoring initiation. Analysis of the primary outcome included 85 subjects assigned to the standard RT assessment group and 116 assigned to the automated monitoring alert group to initiate RT-driven care. There was no significant difference between the study groups in re-intubation rate, median length of stay, mortality, or ICU costs. The RT time associated with patient assessment (P < .001) and therapy provided (P = .031) were significantly lower in the automated continuous monitoring alert group. In subjects who received mechanical ventilation for > 24 h, there were no significant outcome or cost differences between our standard RT assessment tool or an automated monitoring alert to initiate postextubation RT-driven care. Using an automated continuous monitoring alert to initiate RT-driven care saved RT time. (ClinicalTrials.gov registration NCT04231890).

Intensive care unit observation after pancreatectomy: Treating the patient or the surgeon?

Routine intensive care unit admission (ICUA) is commonplace following pancreatectomy, particularly pancreaticoduodenectomy. The value of this practice in avoiding failure-to-rescue is poorly studied. We queried our institutional National Surgical Quality Improvement Project database for patients undergoing pancreatectomy from 2013 to 2020. Postoperative dispositions, ICU courses, and hospital cost data in United States Dollars (USD) were captured. Data were analyzed with multivariable logistic regression. Six-hundred-thirty-seven patients were identified; 404 (63%) underwent pancreaticoduodenectomy. Postoperatively, 398 (99%) pancreaticoduodenectomies and 110 (47%) distal pancreatectomies had ICUA; two-thirds (n = 318, 63%) did not require immediate postoperative ICU-level interventions at ICUA. Of these, 17 (5.3%) subsequently required ICU-level interventions during initial ICUA, most commonly antiarrhythmic infusion (n = 12). Thirty-day and 90-day mortality in patients requiring immediate ICU-level interventions was 5% (n = 10) and 8% (n = 16) versus 0.3% (n = 1) and 1.2% (n = 4) in those without, respectively. Hospital length of stay was significantly longer with initial ICU-level interventions (median 11 vs. 9 days, p < 0.001), as were total ICU costs (mean 8683 vs. 14611 USD, p < 0.001). At high-volume pancreas centers, patients without immediate postoperative ICU-level interventions are very low risk for failure-to-rescue. Ward admission with a low threshold for care escalation presents a significant opportunity for cost-savings and un-burdening ICUs.

Diaphragm Ultrasound: A Valuable Predictor of the Outcome of Extubation. An Observational Pilot Study in Covid-19 Related ARDS.

Because both early and delayed weaning are associated with increased mortality, longer stay in the ICU and higher economic costs, performing extubation once the patient can cope with the respiratory load is completely recommended. Ultrasound Sonography (US) is an available bedside tool that allows a rapid assessment and visualization of the different structures involved in spontaneous breath. M-mode ultrasonography can be useful for the assessment of diaphragm kinetics, providing valuable information about diaphragm disfunction. The aim of this study is to find a correlation between the value of the acceleration of the diaphragm detected with the US M-mode and the outcome of the weaning. We have enrolled 19 patients admitted in our ICU. Each patient underwent the trial with the ultrasound M-mode to assess the acceleration of the diaphragm during the contraction. We have analyzed the results relating them to the outcome of the weaning. While 11 of our patients have had a successful weaning, 8 have failed it, and we can see that the outcome is associated to the values of acceleration. Our study has demonstrated that an assessment of the diaphragm function using US could represent a usable and effective technique as the acceleration is related to the force generated by the diaphragm contraction. In conclusion, the acceleration could be a useful parameter to consider when it comes to the prediction of the outcome of the weaning process.