Intensive Care Unit Costs Research Articles

P-898. Reproducible profiling of eight Brazilian infectious diseases specialist training sites through open databases

Abstract Background Many factors influence the choice of a specialty and a residency training site after essential medical education, including hospital characteristics. We set out to explore characteristics of infectious diseases (ID) and pediatric ID training sites in one Brazilian state, aiming to provide a data-driven input into residency site choice. Number of hospitalizations and age and sex of patients (A) Absolute number of hospitalizations per institution in the 10-year period, and (B) proportion of hospitalizations in each institution along the years. (C) Violin plots of ages for each institution with the same maximum width, and inner boxplots with width proportional to hospitalization count. (D) Frequency plots of male and female patients hospitalized in each institution, with (E) corresponding area plots adding to 100% for every age. Methods We performed a retrospective, descriptive study of hospitalizations in institutions which offer ID and/or peds ID medical training, using Ministry of Health openly available hospitalization databases as sources. We used R software version 4.3.1 for analysis to ensure reproducibility. Procedures performed, length of hospital stay and intensive care unit costs per institution (A) Proportion of diagnostic, clinical, surgical and transplant procedures carried out in each hospital. (B) Proportion of specialty associated with hospital bed used for each hospitalization. (C) Violin plots of days of hospital stay for each institution. (D) Violin plots of total ICU costs (US dollars, log scale) in each hospitalization for each hospital; (E) the same plot, after removing COVID hospitalizations. Results Eight institutions from Rio de Janeiro (RJ) fit the criteria and had available data. From January 2013 to December 2022, they carried out 583,362 hospitalizations. Two hospitals (HGNI, HUPE) accounted for 56.6% of these. The hospitals with peds ID positions (IPPMG, IFF) have different age distributions because one also admits birthing mothers. Most admissions were due to clinical or surgical procedures, with a minority cataloged as diagnostic procedures or cell, tissue and organ transplants. Most patients were discharged within 7 days. HUCFF had the highest proportion of diagnostic and transplant procedures (1.88% and 2.12%, respectively). On average, university hospitals are paid 2∼3 times as much as other institutions per hospitalization. Overall disease burden was diverse, but INI stood out as a center for HIV care. Proportions of ICD-10 chapters or subchapters as leading causes of hospitalization Heatmaps with unsupervised clustering of ICD-10 chapter or subchapter frequency as leading cause of hospitalization, for all hospitalizations (A), for hospitalizations filed under “clinical treatment of infectious and parasitic diseases” or “clinical treatment of HIV/AIDS” (B), or for hospitalizations filed under ICD-10 chapters I or VI (C). Conclusion Hospitals in RJ with ID and peds ID residency spots have distinct workloads, patient profiles, disease burden and government-paid income. Residents from these programs might express similar views, but they do not necessarily reflect the widest picture, and might not be accessible to all interested candidates. Although subjectivity should not be discarded when choosing a training site, open data can inform more precise, transparent distinctions. For example, candidates interested in transplant ID could be more inclined to choose HUCFF, while candidates interested in less complex care could opt for HGNI. The framework we provide can also be employed to analyze other programs and hospitals, such as surgical residencies. Not all hospitals with residency positions feed these databases, thus limiting our analysis. Disclosures All Authors: No reported disclosures

P-1607. Comparison of In-House Versus Reference Laboratory Antifungal Susceptibility Testing on De-Escalation Rates of Echinocandin Therapy for Candidemia

Abstract Background The Mycoses Study Group Education and Research Consortium recommends healthcare facilities who routinely manage invasive fungal infections have access to “timely antifungal susceptibility testing,” and the Infectious Disease Society of America recommends antifungal de-escalation in candidemia within seven days to mitigate excessive drug costs and fungal resistance. In 2020, Ascension Seton hospital network converted from in-house (INH) antifungal susceptibility testing (AFST) to reference laboratory (RFL) testing. Methods This was a multicenter, retrospective cohort study evaluating the stewardship, clinical, and financial impact of RFL use for AFST in patients with candidemia. AFST was performed INH for isolates from May 2017 to Jul 2020 and by RFL for isolates from Aug 2020 to Sep 2023. The primary outcome was rate of antifungal de-escalation from echinocandin to azole therapy by day 7. Secondary outcomes include cost of antifungal treatment, hospital and intensive care unit (ICU) length of stay, days to targeted therapy, turn around time of test (TAT), and all-cause hospital mortality. Inclusion criteria were candidemia diagnosis and empiric echinocandin treatment. Exclusion criteria were diagnoses of candidemia with ocular, meningeal, or cardiac involvement; candidemia due to C. auris; or death before susceptibility resulted. Outcomes were analyzed by Wilcoxon rank sum. Results This study included 85 patients (42 INH and 43 RFL). The most common infectious species were C. albicans (31% INH vs 35% RFL) and N. glabrata (36% INH vs 49% RFL).Rate of de-escalation by day 7 was higher in the INH than RFL group(, 67 vs 35%, p< 0.01) . RFL use significantly increased days to targeted therapy (2 INH vs 6 RFL, p < 0.01), turn around days of test (5 INH vs 12 RFL, p < 0.01), echinocandin days (4 INH vs 9 RFL, p < 0.01), and cost of antifungal treatment ($1145 INH vs $2290 RFL, p < 0.01). There were no differences in additional secondary endpoints. Conclusion Reference laboratory use for AFST was associated with significantly decreased echinocandin de-escalation rate, leading to longer turn around time of test, time to targeted therapy, and cost of antifungal treatment. In-house AFST offered faster susceptibility results and possibly cost savings. Disclosures All Authors: No reported disclosures

Burden and Economic Impact of Respiratory Viral Infections in Adults Aged 60 and Older: A Focus on RSV

Background/Objectives: Respiratory syncytial virus (RSV) represents a significant cause of acute respiratory infections (ARIs) in adults aged 60 years and older, often leading to severe clinical outcomes and high healthcare costs. This study aimed to evaluate the clinical and economic burden of RSV compared to other ARIs, focusing on specific age groups, comorbidities, and demographic factors. Methods: A retrospective observational study was conducted using the electronic medical records of adults aged ≥60 years hospitalized for ARIs, including RSV, in Spain. Direct costs related to hospitalizations, intensive care unit (ICU) admissions, and treatments were analyzed. The study also assessed demographic, clinical, and comorbidity-related factors influencing the economic burden. Results: RSV infections resulted in significantly higher direct costs compared to other ARIs, particularly in patients aged 70–80 years. Comorbidities such as asthma and smoking history were associated with increased costs in RSV cases. Although ICU costs were comparable between groups, hospitalizations for RSV required longer stays and more intensive treatments, amplifying the overall economic burden. Differences in costs by age and sex highlighted the need for tailored clinical management strategies. Conclusions: RSV poses a substantial economic and clinical burden on adults aged 60 years and older, particularly in those with comorbidities. Preventive measures, such as vaccination, could reduce healthcare costs and improve outcomes in this vulnerable population. These findings support the inclusion of RSV vaccines in immunization programs, especially in aging populations like Spain, to alleviate healthcare pressures during peak respiratory disease seasons.

Effect of Enhanced Recovery after Surgery in Morbidly Obese Patients Undergoing Free Flap Breast Reconstruction.

Enhanced recovery after surgery (ERAS) pathways have been widely implemented across many surgical practices, including autologous breast reconstruction. However, the benefits of ERAS in the morbidly obese population have yet to be defined. A retrospective chart review of patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our institution from 2017 to 2022 was performed. Length of stay (LOS), intensive care unit (ICU) utilization, opioid usage, cost, and flap outcomes were analyzed in patients with body mass index greater than 35 before and after ERAS implementation. Thirty-five morbidly obese patients receiving DIEP flap breast reconstruction were identified before ERAS and 18 after ERAS. There were no differences in unilateral versus bilateral or immediate versus delayed reconstruction. LOS decreased with ERAS (3.43 vs. 2.06 days, p < 0.0000001). ICU utilization decreased with ERAS (0.94 vs. 0.0 days, p < 0.0001). Daily and total opioid usage decreased with ERAS (41.8 vs. 17.9 morphine milligram equivalent [MME], p < 0.0001; 190.5 vs. 54.7 MME, p < 0.0001). Financial metrics improved with ERAS, including decreased total cost ($33,454 vs. $25,079, p = 0.0002) and increased cost margin ($4,458 vs. -$8,306, p = 0.004). There were no differences in donor or recipient site outcomes including flap loss, deep venous thrombosis/pulmonary embolism, hernia/bulge, delayed wound healing, revisions, and blood loss. ERAS pathways maintain benefits in the morbidly obese population undergoing abdominally based autologous breast reconstruction, including decreased LOS, ICU utilization, opioid use, and cost while maintaining successful reconstruction outcomes.

Frequency, financial impact, and factors associated with cost outliers in intensive care units: a cohort study in Belgium.

This study aimed to explore the association between high outliers and intensive care unit admissions and to identify the factors contributing to high intensive care unit costs. This retrospective cohort study used data from 17 Belgian hospitals from 2018 and 2019. The study focused on the 10 most frequently admitted diagnosis-related groups in the intensive care unit. The dataset included medical discharge summaries and cost per stay from the hospital perspective. A total of 39,279 hospital stays were analyzed, 11,124 of which were intensive care unit admissions; additionally, 2,500 of these stays were high outliers. The proportion of high outliers was significantly greater in the intensive care unit group, and admission to the intensive care unit was significantly associated with high outliers in the multivariate analyses. Factors associated with high intensive care unit outliers included the medical diagnosis-related group category, patients from nursing homes, intensive care unit stay duration exceeding 4 days, and specific technical procedures (measurement of intracranial pressure, continuous hemofiltration, and mechanical ventilation). Admission to the intensive care unit increases the likelihood of being classified as an outlier, thus significantly impacting hospital costs. This study identified factors that can be used to predict intensive care unit outliers, which can enable adjustments to diagnosis-related group-based funding for intensive care units.

Ventilator-associated pneumonia rates in a level I trauma intensive care unit in KwaZulu-Natal Province, South Africa, compared with international benchmarks.

Ventilator-associated pneumonia (VAP) is a common nosocomial infection in critically ill patients in intensive care units (ICUs) worldwide. Despite the huge healthcare economic burden and the significant negative morbidity and mortality impact of VAP, its incidence and outcomes in the trauma ICU (TICU) population were poorly documented in South Africa (SA). To determine the incidence of VAP in a level I trauma centre at Inkosi Albert Luthuli Central Hospital in Durban, SA, compared with international benchmarks. Determining mortality rates, the average length and cost of ICU stay, ventilator days and antibiotic consumption was a secondary objective. This retrospective chart review of the trauma registry at the centre examined the incidence of VAP and secondary outcomes over the period January 2017 - December 2019. A data pro forma was used with VAP diagnoses as per the 2015 Centers for Disease Control and Prevention definitions. The comparator was international literature-based benchmark VAP rates in TICUs. The study included 395 patients, of whom 143 (36.2%) were diagnosed with VAP. The VAP rate was calculated to be 35.6 per 1 000 ventilator days. Thirty-one patients with VAP (21.7%) died in the ICU, a similar figure to that for the non-VAP group (22.6%). There were no statistically significant differences in age, sex, mechanism of injury or Injury Severity Score between the VAP and non-VAP groups (p>0.05). There were statistically significant differences between the two groups in number of days on mechanical ventilation, ICU length of stay and ICU cost. The VAP group had a median of 12 ventilation days v. 5 days for the non-VAP group (p<0.001), and spent a median of 7 days longer in the ICU (p<0.001). The median cost of ICU stay for VAP patients was almost double that for non-VAP patients (p<0.001). VAP rates in this local TICU were similar to international rates. Trauma patients, especially those with traumatic brain injury, are at higher risk of VAP than general ICU patients, so strict adherence to evidence-based VAP prevention bundles is necessary among TICU staff. This study is the first to assess ventilator-associated pneumonia rates in a South African trauma-specific intensive care unit compared with national and international benchmarks, and sets the standard for local morbidity and mortality norms.

Bibliometric Analysis of Studies on Delirium in Critical Care

Background Delirium leads to prolongation in intensive care unit (ICU) and hospital length of stay and an increase in ICU costs and mortality. As a result of this, the number of studies on delirium in ICUs has recently increased significantly, and many articles have been published. Objectives The aim of this study was to evaluate the articles related to “delirium” in “critical care” field in the Web of Science database and the first hundred most cited articles on this subject. Methods The Web of Science database was searched for articles relevant to “delirium” in the critical care medicine field published between 1980 and 2024. Text analytics and network models used in bibliometric mapping were used for prolific authors, annual trend, citation, and countries. Results In our study, it was determined that a total of 1834 articles in the field of delirium in critical care medicine were included. It was determined that the annual citation average was 42.79 and the H-index value was 134. There is a general upward trend over the years, and it was observed that it has intensified in the last 5 to 6 years. With the Reference Spectroscopy analysis, it was determined that the most intensively cited studies on delirium were the studies of 2013 and 2010. The distribution of keywords in recent years has focused on analgosedation, acute brain injury, older patient, COVID-19, and fragility. When examined for the top 100 cited articles, it was seen that mobilization, guidelines, pain, activities of daily living, anesthesia, sedation, and haloperidol have become prominent in recent years. Conclusion In recent years, there has been a noticeable increase in the volume of research focusing on delirium studies within the field of critical care medicine. Staying current with trends, incorporating findings from frequently cited studies, and customizing interventions to suit modern difficulties can all improve the quality of care offered to critically ill patients and lead to better outcomes.

Direct healthcare costs for people with cerebral palsy in the Brazilian unified health system between 2015 and 2019

ABSTRACT Background Estimate the costs of inpatient and outpatient care for people with Cerebral Palsy (CP) in Brazil. Research design and methods Health records of people with CP in the Hospital and Outpatient Information Systems of Brazil between 2015 and 2019 were analyzed. Variables analyzed were gender, age, ICD, Intensive Care Unit (ICU) use, total cost, and ICU cost. Costs were adjusted for inflation and converted to dollars. Linear regression analysis was performed to investigate the association between social and clinical variables and direct costs. Results A total direct cost of approximately $166 million to the National Health System was identified, with $7.08 million/year and $26.1 million/year of inpatient and outpatient costs, respectively. The healthcare was primarily for children up to 14 years of age. The ICD ‘spastic quadriplegic CP’ received the most attendance. Rehabilitation was responsible for 75% of the outpatient care, with physiotherapy standing out. Increased age, use of ICU, and the types of CP are related to increased cost. Conclusions Healthcare for people with CP produced expressive costs for the Brazilian public health system, mainly with outpatient procedures and rehabilitation, with children being the most attended. Estimating these costs assist in better resource allocation for more effective healthcare provision.

Patient-level cost analysis of intensive care unit-acquired infections: a prospective cohort study

Hospital-associated infections (HAIs) are associated with increased mortality and prolonged hospital length-of-stay (LOS). Although some studies have shown that HAIs are associated with increased costs, these studies only used cost estimates, were carried out in a small number of centres, or only in high-income countries. We carried out a prospective cohort study in ten Brazilian intensive care units (ICUs) selected from a collaborative platform study (IMPACTO MR). We included all patients aged 18 years or older admitted from October 2019 to December 2021 and who had an ICU LOS of at least two days. The costs were adjusted for official inflation until December 2022 and converted into international dollars using the 2021 purchasing power parity (PPP) conversion rate. We used a propensity score matching method to compare patients with HAIs and patients without HAIs, and patients with and without ventilator-associated pneumonia (VAP), central-line bloodstream infection (CLABSI), catheter-associated urinary tract infection (CA-UTI) and multidrug-resistant (MDR) HAIs. We included 7,953 patients in the study, of whom 574 (7.2%) had an HAI during their ICU stay. After propensity-score matching, patients with HAIs had ICU costs that were more than three times higher than those of patients without HAIs [$ 19,642 (IQR; 12,884-35,134) vs. 6,086 (IQR; 3,268-12,550); p <0.001). Patients with VAP, CLABSI, and CA-UTI, but not with MDR-HAIs also had higher total ICU costs. HAIs acquired in the ICU are associated with higher ICU costs. These findings were consistent across specific types of infection.

Healthcare costs related to respiratory syncytial virus in paediatric intensive care units in the Netherlands: a nationwide prospective observational study (the BRICK study)

The implementation of the approved respiratory syncytial virus (RSV) preventive interventions in immunisation programmes is advancing rapidly. Insight into healthcare costs of RSV-related paediatric intensive care unit (PICU) admissions is lacking, but of great importance to evaluate the impact of implementation. Therefore, this study aimed to determine the total annual RSV-related paediatric intensive care healthcare costs in the Netherlands. A nationwide prospective, observational, multicenter study was performed from September 2021 until June 2023. The total annual RSV-related healthcare costs on PICUs in the Netherlands were calculated using RSV-related costs (subgroup I) and consequential costs (subgroup II and III). Subgroup I comprised all PICU admitted infants ≤12 months of age with laboratory-confirmed RSV infection. Subgroup II and III consisted of postponed elective PICU admissions and refused acute PICU admissions due to RSV-related lack of PICU capacity. A total of 424 infants with RSV-related PICU admission were included. Median age at PICU admission was 46 days (IQR 25-89). The median length of PICU admission was 5 days (IQR 3-8). The total RSV-related PICU costs are € 3,826,386 in 2021-2022, and € 3,183,888 in 2022-2023. Potential costs averted by RSV preventive interventions is € 1.9 to € 2.6 million depending on season, and the duration of protection. RSV-related PICU admissions cost €3.1 to €3.8 million in the Netherlands during one season. The introduction of new RSV preventive interventions into the Dutch immunisation programme will generate significant cost-savings on PICUs and decreases the admission burden of PICUs. None.

Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea.

The decision to discontinue intensive care unit (ICU) treatment during the end-oflife stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization. We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not. Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P<0.001), and higher ICU readmission rates than the control group. There were no significant differences in the healthcare costs of ICU stay between the two groups. Most LST decisions (86%) were made by family. The decisions to withdraw LST of ICU inpatients were influenced by age, readmission, and disease category. ICU costs were similar between the withdrawal and control groups. Further research is needed to tailor LST decisions in the ICU.

A machine learning model for the early diagnosis of bloodstream infection in patients admitted to the pediatric intensive care unit.

Bloodstream infection (BSI) is associated with increased morbidity and mortality in the pediatric intensive care unit (PICU) and high healthcare costs. Early detection and appropriate treatment of BSI may improve patient's outcome. Data on machine-learning models to predict BSI in pediatric patients are limited and neither study included time series data. We aimed to develop a machine learning model to predict an early diagnosis of BSI in patients admitted to the PICU. This was a retrospective cohort study of patients who had at least one positive blood culture result during stay at a PICU of a tertiary-care university hospital, from January 1st to December 31st 2019. Patients with positive blood culture results with growth of contaminants and those with incomplete data were excluded. Models were developed using demographic, clinical and laboratory data collected from the electronic medical record. Laboratory data (complete blood cell counts with differential and C-reactive protein) and vital signs (heart rate, respiratory rate, blood pressure, temperature, oxygen saturation) were obtained 72 hours before and on the day of blood culture collection. A total of 8816 data from 76 patients were processed by the models. The machine committee was the best-performing model, showing accuracy of 99.33%, precision of 98.89%, sensitivity of 100% and specificity of 98.46%. Hence, we developed a model using demographic, clinical and laboratory data collected on a routine basis that was able to detect BSI with excellent accuracy and precision, and high sensitivity and specificity. The inclusion of vital signs and laboratory data variation over time allowed the model to identify temporal changes that could be suggestive of the diagnosis of BSI. Our model might help the medical team in clinical-decision making by creating an alert in the electronic medical record, which may allow early antimicrobial initiation and better outcomes.

Immediate Compared With Deferred Treatment for Gestational Diabetes Mellitus: A Cost-Effectiveness Analysis [ID 2683592

INTRODUCTION: Current recommendations for gestational diabetes mellitus (GDM) include screening and treatment at 24–28 weeks’ gestational age. Whether treatment prior to 24–28 weeks improves maternal and infant outcomes is unclear. A recent randomized trial found that immediate treatment of GDM at 20 weeks led to lower incidence of several adverse neonatal outcomes including respiratory distress syndrome (RDS) and shoulder dystocia with brachial plexus injury (BPI). We evaluated the clinical benefits and cost effectiveness of immediate versus deferred treatment in pregnant women with GDM. METHODS: We used TreeAge to construct a decision-analytic model comparing outcomes between those who received immediate versus deferred GDM treatment. Our theoretical cohort was 71,679, the approximate number of GDM cases diagnosed early in the United States annually. Outcomes were BPI, RDS with neonatal intensive care unit admission, neurodevelopmental delay (NDD), cost, and quality-adjusted life years (QALYs). Probabilities were derived from a recent randomized trial and other peer-reviewed literature. We used a discount rate of 3% and a willingness-to-pay of $100,000/QALY. RESULTS: In our theoretical cohort, immediate treatment led to fewer cases of BPI (25 versus 77), RDS (7,054 versus 12,176). There was no difference between either treatment for NDD. Despite increased costs, immediate treatment was a cost-effective strategy as it resulted in increased QALYs with an incremental cost-effectiveness ratio of $54,434/QALY. CONCLUSION: Immediate treatment was a clinically beneficial and cost-effective strategy to reduce cases of BPI and RDS. Given improvement of certain neonatal outcomes, it may be beneficial to screen and immediately treat early-onset GDM.

Predictors, prognosis and costs of prolonged intensive care unit stay after surgery for type A aortic dissection.

The outcomes after prolonged treatment in the intensive care unit (ICU) after surgery for Stanford type A aortic dissection (TAAD) have not been previously investigated. This analysis included 3538 patients from a multicenter study who underwent surgery for acute TAAD and were admitted to the cardiac surgical ICU. The mean length of stay in the cardiac surgical ICU was 9.9±9.5 days. The mean overall costs of treatment in the cardiac surgical ICU 24086±32084 €. In-hospital mortality was 14.8% and 5-year mortality was 30.5%. Adjusted analyses showed that prolonged ICU stay was associated with significantly lower risk of in-hospital mortality (adjusted OR 0.971, 95%CI 0.959-0.982), and of five-year mortality (adjusted OR 0.970, 95%CI 0.962-0.977), respectively. Propensity score matching analysis yielded 870 pairs of patients with short ICU stay (2-5 days) and long ICU stay (>5 days) with balanced baseline, operative and postoperative variables. Patients with prolonged ICU stay (>5 days) had significantly lower in-hospital mortality (8.9% vs. 17.4%, <0.001) and 5-year mortality (28.2% vs. 30.7%, P=0.007) compared to patients with short ICU-stay (2-5 days). Prolonged ICU stay was common after surgery for acute TAAD. However, when adjusted for multiple baseline and operative variables as well as adverse postoperative events and the cluster effect of hospitals, it was associated with favorable survival up to 5 years after surgery.

Effects of diaphragm electrical stimulation in treating respiratory dysfunction on mechanical ventilation after intracerebral hemorrhage: A single-center retrospective study.

Intracerebral hemorrhage (ICH) is a major cause of death and disability worldwide. The benefits of electrical stimulation in the treatment of respiratory dysfunction in patients on mechanical ventilation is unknown. Nevertheless, there is a dearth of evidence-based medical research concerning its clinical efficacy. From January 2019 to January 2023, every enrolled patients experienced respiratory dysfunction after ICH while being supported by mechanical ventilation. A total of 205 eligible patients were enrolled and then allocated into 2 groups: control group and observation group. 133 patients was selected and administered standard treatment as control group. Based on conventional treatment, other 72 patients were administered diaphragm electrical stimulation (DES) treatment. We examined information from current medical records, encompassing all initial data and predictive follow-up data, such as the weaning success rate, occurrence of ventilator-associated pneumonia (VAP), duration of stay in the intensive care unit (ICU) and hospital, expenses related to hospitalization, and mortality within 30 days. The baseline clinical data of the 2 groups did not exhibit any statistically significant disparities (all P > .05). The rate of successful weaning showed a significant increase in the DES group when compared to the control group (P = .025). In patients with respiratory dysfunction due to ICH, treatment with DES resulted in a significant reduction in the duration of invasive ventilation (9.8 ± 2.1 vs 11.2 ± 2.6, P < .01) and total ventilation time (9.8 ± 2.1 vs 11.2 ± 2.6, P < .01). It also led to a decrease in the length of stay in the ICU (15.67 ± 3.76 vs 17.53 ± 4.28, P = .002) and hospitalization cost (11500 vs 13600, P = .001). Additionally, DES treatment resulted in a lower incidence of VAP (73.61% vs 86.46%, P = .022) and improved 30-day mortality (P < .05), without any significant adverse effects. The findings of this research indicate that DESs have a positive impact on enhancing the rate of successful weaning and reducing the incidence of VAP. It decreases the duration of invasive ventilation and total ventilation time while also improving the mortality rate within 30 days. This therapy could offer a fresh alternative for respiratory impairment in patients undergoing mechanical ventilation.

Nutritional responsiveness affects novel neutrophil parameters and reduces in-hospital mortality and costs in elective cancer oesophagectomy - a single centre, prospective, observational study.

Malnutrition in surgical patients remains a common issue affecting the perioperative period. Oesophageal cancer is a disease associated with one of the highest malnutrition rates. Assessment of patient nutritional status remains a challenge due to limited validated tools. Novel parameters to identify malnourished patients and the effectiveness of preoperative nutritional intervention might improve treatment results in the perioperative period. This was a prospective, observational, single-centre study of patients scheduled for elective oesophagectomy. The primary aim of this study was to establish the correlation between neutrophil reactivity intensity (NEUT-RI) and neutrophil granularity intensity (NEUT-GI) and patients' nutritional status. We divided patients into nutritional responders (R group) and nutritional non-responders (NR group) defined as regaining at least 25% of the maximum preoperative body weight loss during the preoperative period. The R group had significantly shorter intensive care unit (ICU) stays: 5.5 (4-8) vs. 13 (7-31) days ( P = 0.01). It resulted in a lower cost of ICU stays in the R group: 4775.2 (3938.9-7640.7) vs. 12255.8 (7787.6-49108.7) euro in the NR group ( P = 0.01). Between the R group and the NR group, we observed statistically significant differences in both preoperative NEUT-RI (48.6 vs. 53.4, P = 0.03) and NEUT-GI (154.6 vs. 159.3, P = 0.02). Apart from the T grade, the only preoperative factor associated with reduced mortality was the nutritional responsiveness: 11.1% vs. 71.4% ( P = 0.008). Preoperative nutritional responsiveness affects neutrophil intensity indexes and reduces in-hospital mortality and costs associated with hospital stay. Further research is required to determine the correlation between novel neutrophil parameters and patients' nutritional status.

Cost-Effectiveness of Early Goal-Directed Therapy Using the FloTrac/EV1000 Platform in Patients Undergoing Coronary Artery Bypass Graft with Cardiopulmonary Bypass: A Retrospective Analysis

Background: Coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) is a high-risk surgery with significant morbidity resulting in a prolonged stay in the intensive care unit (ICU) at an increased cost. Early goal-directed therapy (EGDT) using the FloTrac/EV1000 platform improved outcomes in these patients with shorter ICU stay but with extra cost for a FloTrac transducer. Objective: To assess the cost-effectiveness of implementing the FloTrac/EV1000 in these patients. Materials and Methods: The present study was a retrospective study. Sixty adult patients who underwent CABG with CPB were included and divided into two groups: the EV1000 and the Control group. The EV1000 group was managed with EGDT protocol using FloTrac/EV1000 platform. The Control group was managed using a standard protocol. The ICU and hospital stay of both groups were compared. Then, the authors assessed the daily ICU cost by including another 62 patients admitted to the cardiovascular and thoracic (CVT) ICU. Finally, the extra cost of a FloTrac transducer was compared with the saved CVT ICU cost. Results: The EV1000 group had a shorter CVT ICU stay, with mean difference of –23.7 h (95% CI –34.5 to –12.9, p&lt;0.001). The EV1000 group had a shorter ventilator time, as well as a shorter hospital stay. The average daily CVT ICU cost was 10,020.05 Baht. The extra cost of a FloTrac sensor was 5,000 Baht. The saved cost of CVT ICU exceeds the cost of a FloTrac by 5,020.05 Baht. Conclusion: The implementation of EGDT using the FloTrac/EV1000 platform in patients undergoing CABG with CPB improved patients’ outcomes resulting in less CVT ICU cost and better resource management of CVT ICU beds. The extra cost of the FloTrac sensor was offset by the larger amount of CVT ICU cost that was saved. Keywords: Cost-effectiveness; Early goal-directed therapy; FloTrac; Intensive care unit; ICU stay

Post-pancreatectomy acute pancreatitis after pancreatoduodenectomy: Analysis of a clinically-relevant complication in a single-center retrospective study

Background/Objectives: This study aimed to evaluate the frequency, clinical impact, and risk factors of post-pancreatectomy acute pancreatitis (PPAP) after pancreatoduodenectomy (PD) according to the definition proposed by the International Study Group for Pancreatic Surgery (ISGPS). Methodspatients undergoing PD between 2010 and 2021 were retrospectively analyzed. PPAP was defined according to the ISGPS criteria, including elevated serum amylase for 48 h and concurring pancreatitis alterations on a CT scan. Results272 patients were finally included in the study. PPAP occurred in 40 (14.7 %) patients, and it was significantly related to higher rates of clinically-relevant postoperative pancreatic fistula (CR-POPF) (p < 0.001), post-pancreatectomy hemorrhage (PPH) (p < 0.001) and major complications (Clavien-Dindo ≥ 3a) (p < 0.001). Moreover, PPAP in the absence of CR-POPF (n = 18) was significantly related to longer hospital stay (p < 0.001), PPH (p < 0.001), major complications (Clavien-Dindo≥ 3a, p = 0.001) and higher intensive care unit costs (p = 0.029) compared to patients not developing PPAP. In the univariable and multivariable analysis, the duct size (p = 0.004) and high-risk pathologies (p = 0.004) but not intraoperative bleeding (p = 0.066) represented independent risk factors for PPAP. In the same analysis, patients receiving a bridging therapy with low molecular-weight heparin showed significantly lower rates of PPAP (p = 0.045). ConclusionsPPAP represents a relevant complication after PD. Its risk factors are similar to those for CR-POPF, while anticoagulants could represent a possible prevention strategy.

Dynamic Delirium Prediction in the Intensive Care Unit using Machine Learning on Electronic Health Records.

Delirium is a syndrome of acute brain failure which is prevalent amongst older adults in the Intensive Care Unit (ICU). Incidence of delirium can significantly worsen prognosis and increase mortality, therefore necessitating its rapid and continual assessment in the ICU. Currently, the common approach for delirium assessment is manual and sporadic. Hence, there exists a critical need for a robust and automated system for predicting delirium in the ICU. In this work, we develop a machine learning (ML) system for real-time prediction of delirium using Electronic Health Record (EHR) data. Unlike prior approaches which provide one delirium prediction label per entire ICU stay, our approach provides predictions every 12 hours. We use the latest 12 hours of ICU data, along with patient demographic and medical history data, to predict delirium risk in the next 12-hour window. This enables delirium risk prediction as soon as 12 hours after ICU admission. We train and test four ML classification algorithms on longitudinal EHR data pertaining to 16,327 ICU stays of 13,395 patients covering a total of 56,297 12-hour windows in the ICU to predict the dynamic incidence of delirium. The best performing algorithm was Categorical Boosting which achieved an area under receiver operating characteristic curve (AUROC) of 0.87 (95% Confidence Interval; C.I, 0.86-0.87). The deployment of this ML system in ICUs can enable early identification of delirium, thereby reducing its deleterious impact on long-term adverse outcomes, such as ICU cost, length of stay and mortality.

Limitation of Non-Beneficial Interventions and their Impact on the Intensive Care Unit Costs.

Using a plan to limit non-beneficial life support interventions has significantly reduced harm and loss of dignity for patients at the end of life. The association of these limitations with patients' clinical characteristics and health care costs in the intensive care unit (ICU) needs further scientific evidence. To explore decisions to limit non-beneficial life support interventions, their correlation with patients' clinical data, and their effect on the cost of care in the ICU. We included all patients admitted to the general ICU of a hospital in Greece in a two-year (2019-2021) prospective study. Data collection included patient demographic and clinical variables, data related to decisions to limit (withholding, withdrawing) non-beneficial interventions (NBIs), and economic data. Comparisons were made between patients with and without limitation decisions. NBIs were limited in 164 of 454 patients (36.12%). Patients with limitation decisions were associated with older age (70y vs. 62y; p<0,001), greater disease severity score (APACHE IV, 71 vs. 50; p<0,001), longer length of stay (7d vs. 4.5d; p<0,001), and worse prognosis of death (APACHE IV PDR, 48.9 vs. 17.35; p<0,001). All cost categories and total cost per patient were also higher than the patient without limitation of NBIs (9247,79€ vs. 8029,46€, p<0,004). The mean daily cost has not differed between the groups (831,24€ vs. 832,59€; p<0,716). However, in the group of patients with limitations, all cost categories, including the average daily cost (767.31€ vs. 649.12€) after the limitation of NBIs, were reduced to a statistically significant degree (p<0.001). Limiting NBIs in the ICU reduces healthcare costs and may lead to better management of ICU resource use.