Wesley H Self1, Dandan Liu2, Nicholas Strayer2, Stephan Russ3, Michael J Ward3, Nathan I Shapiro4, Todd W Rice5, Matthew W Semler5. 1. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: wesley.self@vumc.org. 2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN. 3. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. 4. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 5. Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
Abstract
BACKGROUND: Septic shock therapies that shorten the time to physiologic and clinical recovery may result in financial savings. However, the financial implications of improving these nonmortal outcomes are not well characterized. Therefore, we quantified hospital charges associated with four outcomes: ICU length of stay, duration of invasive mechanical ventilation, duration of vasopressor use, and new renal replacement therapy. METHODS: This was an observational study using administrative data from a large academic hospital in the United States. The analysis included adults treated with vasopressors for septic shock in a medical ICU. Linear regression modeling with ordinary least square was used to estimate the incremental hospital charges associated with 1 day of ICU length of stay, 1 day of mechanical ventilation, 1 day of vasopressor use, and new renal replacement therapy. RESULTS: The study population included 587 adults with septic shock, including 180 (30.7%) who died in the hospital. The median charge for a septic shock hospitalization was $98,583 (interquartile range [IQR], $61,177-$136,672). Decreases in ICU length of stay, mechanical ventilation duration, and vasopressor duration of 1 day were associated with charge reductions of $15,670 (IQR, $15,023-$16,317), $15,284 (IQR, $13,566-$17,002), and $17,947 (IQR, $16,344-$19,549), respectively. Avoidance of new renal replacement therapy was associated with a charge reduction of $36,051 (IQR, $22,353-$49,750). CONCLUSIONS: Septic shock therapies that reduce the duration of organ support and ICU care have the potential to lead to substantial financial savings.
BACKGROUND: Septic shock therapies that shorten the time to physiologic and clinical recovery may result in financial savings. However, the financial implications of improving these nonmortal outcomes are not well characterized. Therefore, we quantified hospital charges associated with four outcomes: ICU length of stay, duration of invasive mechanical ventilation, duration of vasopressor use, and new renal replacement therapy. METHODS: This was an observational study using administrative data from a large academic hospital in the United States. The analysis included adults treated with vasopressors for septic shock in a medical ICU. Linear regression modeling with ordinary least square was used to estimate the incremental hospital charges associated with 1 day of ICU length of stay, 1 day of mechanical ventilation, 1 day of vasopressor use, and new renal replacement therapy. RESULTS: The study population included 587 adults with septic shock, including 180 (30.7%) who died in the hospital. The median charge for a septic shock hospitalization was $98,583 (interquartile range [IQR], $61,177-$136,672). Decreases in ICU length of stay, mechanical ventilation duration, and vasopressor duration of 1 day were associated with charge reductions of $15,670 (IQR, $15,023-$16,317), $15,284 (IQR, $13,566-$17,002), and $17,947 (IQR, $16,344-$19,549), respectively. Avoidance of new renal replacement therapy was associated with a charge reduction of $36,051 (IQR, $22,353-$49,750). CONCLUSIONS: Septic shock therapies that reduce the duration of organ support and ICU care have the potential to lead to substantial financial savings.
Authors: V Marco Ranieri; B Taylor Thompson; Philip S Barie; Jean-François Dhainaut; Ivor S Douglas; Simon Finfer; Bengt Gårdlund; John C Marshall; Andrew Rhodes; Antonio Artigas; Didier Payen; Jyrki Tenhunen; Hussein R Al-Khalidi; Vivian Thompson; Jonathan Janes; William L Macias; Burkhard Vangerow; Mark D Williams Journal: N Engl J Med Date: 2012-05-22 Impact factor: 91.245
Authors: P P Pandharipande; T D Girard; J C Jackson; A Morandi; J L Thompson; B T Pun; N E Brummel; C G Hughes; E E Vasilevskis; A K Shintani; K G Moons; S K Geevarghese; A Canonico; R O Hopkins; G R Bernard; R S Dittus; E W Ely Journal: N Engl J Med Date: 2013-10-03 Impact factor: 91.245