Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants
Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants
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DOI：
10.1542/peds.114.2.348
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发表时间：
2004-08-01
期刊：
影响因子：
8
通讯作者：
Rogowski, J
中科院分区：
文献类型：
--
作者：
Payne, NR;Carpenter, JH;Rogowski, J
Objective.医院内血流感染（NBIs）与极低出生体重儿（VLBW）的严重发病率和住院时间（LOS）延长有关。然而，与这些感染相关的边际成本和超额LOS从未在调整许多潜在的混杂人口统计学变量、合并症和治疗后，在不同的出生体重（BW）类别中进行过测量。本研究的目的是测量NBIs在不同BW类别的存活VLBW婴儿中引起的边际成本和超额LOS。这项回顾性研究检查了以前收集的数据，作为2000年新生儿重症监护质量改进协作和佛蒙特州牛津网络临床结局数据库的一部分。单因素分析和多元回归分析，以探讨影响住院费用和住院服务。17个新生儿重症监护室参加了2000年新生儿重症监护质量改进协作，提交了1998年1月1日至1999年12月31日出生的极低出生体重婴儿的临床和财务数据。本研究包括来自大学和社区医院的数据。在本研究纳入的2809例患者中，19.7%发生了NBI。对于体重751 - 1500 g的婴儿，NBI与治疗费用显著增加相关。多元回归估计，非生物指标的边际成本从体重为401 - 750 g的极低出生体重婴儿的5875美元到体重为751 - 1000 g的婴儿的12480美元不等。在所有BW类别中，LOS显著增加。通过多元回归估计的超额LOS从BW为1001至1251 g的VLBW婴儿的4天到BW为751至1000 g的VLBW婴儿的7天不等。NBI与医院治疗费用和LOS增加有关，但数量取决于BW。预防单一NBI可以减少VLBW婴儿的治疗费用至少数千美元。体重1001 - 1500 g的极低出生体重婴儿的这些节省在总治疗费用中所占的百分比高于较小婴儿。
Objective. Nosocomial bloodstream infections (NBIs) are associated with serious morbidity and prolonged length of stay (LOS) in very low birth weight (VLBW) infants. However, the marginal costs and excess LOS associated with these infections have never been measured in different birth weight (BW) categories after adjustment for many of the potentially confounding demographic variables, comorbidities, and treatments. The objective of this study was to measure the marginal cost and excess LOS caused by NBIs in surviving VLBW infants in different BW categories.Methods. This retrospective study examined data previously collected as part of the Neonatal Intensive Care Quality Improvement Collaborative 2000 and the Vermont Oxford Network clinical outcomes database. Univariate analyses and multiple regression were used to examine the effect of NBIs on hospital costs and LOS. Seventeen neonatal intensive care units that participated in the Neonatal Intensive Care Quality Improvement Collaborative 2000 submitted both clinical and financial data on their VLBW infants who were born from January 1, 1998, to December 31, 1999. This study included data from both university and community hospitals.Results. NBIs occurred in 19.7% of 2809 patients included in this study. NBI was associated with significantly increased treatment costs for infants with BW 751 to 1500 g. The marginal costs of NBIs, as estimated by multiple regression, varied from $5875 for VLBW infants with a BW of 401 to 750 g to $12 480 for those with BW of 751 to 1000 g. LOS was significantly increased in all BW categories. The excess LOS estimated by multiple regression varied from 4 days in VLBW infants with a BW of 1001 to 1251 g to 7 days in those with a BW of 751 to 1000 g.Conclusions. NBIs are associated with increased hospital treatment costs and LOS but by varying amounts depending on the BW. Preventing a single NBI could reduce the treatment costs of a VLBW infant by at least several thousand dollars. These savings are a greater percentage of the total treatment costs in VLBW infants with BW 1001 to 1500 g than in smaller infants.