Bram P Raphael1, Christina Hazekamp1,2, Mihail Samnaliev3, Al Ozonoff2,4. 1. Division of Gastroenterology, Hepatology and Nutrition. 2. Center for Applied Pediatric Quality Analytics, Boston Children's Hospital. 3. Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School. 4. Department of Pediatrics, Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: Although previous literature suggests home parenteral nutrition (HPN)-dependent children experience frequent complications like community-acquired central line-associated bloodstream infections (CLABSI), few studies have characterized the cost. OBJECTIVE: The aim of this study was to evaluate institutional cost of community-acquired CLABSI in pediatric patients with HPN. METHODS: This is a single-center retrospective review of institutional costs for patients with HPN with community-acquired CLABSI at a tertiary care children's hospital. Inclusion was age 18 years or less between October 2011 and April 2016. Exclusions were death during hospitalization and readmission within 2 days of discharge. Patient-level factors were compared between high-cost group and all others using Welch 2-sample t test and analysis of variance. Multivariable logistic regression was used to determine predictors of higher cost. RESULTS: There were 176 CLABSI admissions among 68 patients during the study period (median 2 hospitalizations per patients). The mean cost and length of stay per hospital admission are $28,375 (2015 US dollars) and 8 days, and both were associated with intensive care unit admission (ICU), central venous catheter removal, private insurance, and age <2 years at admission. Nine percent of patients were classified as "super-utilizers" whose 54 hospitalizations accounted for 28% of total institutional costs. CONCLUSIONS: Among pediatric patients with HPN, community-acquired CLABSI is associated with significant cost and length of stay. Healthcare utilization is disproportionately concentrated in a small number of patients. These study findings may help inform cost analysis for future CLABSI prevention strategies.
BACKGROUND: Although previous literature suggests home parenteral nutrition (HPN)-dependent children experience frequent complications like community-acquired central line-associated bloodstream infections (CLABSI), few studies have characterized the cost. OBJECTIVE: The aim of this study was to evaluate institutional cost of community-acquired CLABSI in pediatric patients with HPN. METHODS: This is a single-center retrospective review of institutional costs for patients with HPN with community-acquired CLABSI at a tertiary care children's hospital. Inclusion was age 18 years or less between October 2011 and April 2016. Exclusions were death during hospitalization and readmission within 2 days of discharge. Patient-level factors were compared between high-cost group and all others using Welch 2-sample t test and analysis of variance. Multivariable logistic regression was used to determine predictors of higher cost. RESULTS: There were 176 CLABSI admissions among 68 patients during the study period (median 2 hospitalizations per patients). The mean cost and length of stay per hospital admission are $28,375 (2015 US dollars) and 8 days, and both were associated with intensive care unit admission (ICU), central venous catheter removal, private insurance, and age <2 years at admission. Nine percent of patients were classified as "super-utilizers" whose 54 hospitalizations accounted for 28% of total institutional costs. CONCLUSIONS: Among pediatric patients with HPN, community-acquired CLABSI is associated with significant cost and length of stay. Healthcare utilization is disproportionately concentrated in a small number of patients. These study findings may help inform cost analysis for future CLABSI prevention strategies.
Authors: Brendan C Jones; Benjamin O'Sullivan; Sonal Parmar Amin; Susan Hill; Simon Eaton; Paolo De Coppi Journal: Pediatr Surg Int Date: 2022-02-24 Impact factor: 1.827
Authors: Angharad Vernon-Roberts; Robert N Lopez; Christopher M Frampton; Andrew S Day Journal: JPEN J Parenter Enteral Nutr Date: 2022-03-25 Impact factor: 3.896