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J Clin Outcomes Manage
2006 Dec;13(12):685-691
Clinical and economic outcomes of postoperative hospital-acquired pneumonia patients who receive invasive diagnostic testing or ventilation
Thompson DA, Needham DM, Pronovost PJ
Abstract Objective: To describe the clinical and economic impact of traditional technologies used in the diagnosis and management of intra-abdominal postoperative surgical patients who develop hospital-acquired pneumonia (HAP). Methods: We used the National Inpatient Sample (NIS) database to identify patients with intra-abdominal operations and pneumonia diagnoses for the period 1 January to 31 December 2000 using clinical classification software codes. Independent variables collected were age at time of hospitalization, race, sex, and whether the patient had bronchoalveolar lavage (BAL), closed-lung biopsy, or mechanical ventilation. A discharge weight was applied to provide a nationally representative sample; this weight was used throughout analyses. A separate discharge weight (a variable in NIS) used for cost analysis. Results: 13,292 patients had HAP following intra-abdominal surgery. Mortality rate for these patients was 10.7%. Zero of 310 HAP patients undergoing BAL died compared with 1421 (10.7%) patients not undergoing BAL. HAP–closed-lung biopsy patients had higher mortality (26%) as compared with those not undergoing biopsy (9.7%). HAP–mechanically ventilated patients had higher mortality (22%) as compared with those not ventilated (7.8%). HAP–mechanical ventilation was associated with a 1.36-fold increased risk of discharge to a nursing facility and mean increase in charges of $125,614. HAP–closed-lung biopsy resulted in 33.34-day mean increased length of stay. Conclusion: Given the high incidence and significant impact of HAP on patient outcomes, early preventive strategies and interventions to reduce HAP should be a priority.
Original Research
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