Background: Patients with stroke receiving invasive mechanical ventilation (IMV) and tracheostomy incur intense treatment and long hospitalizations. We aimed to evaluate US hospitalization costs for patients with stroke requiring IMV, tracheostomy, or no ventilation.
Methods: We performed a retrospective observational study of US hospitalizations for acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage receiving IMV, tracheostomy, or none using the National Inpatient Sample, 2008 to 2017. We calculated hospitalization costs using cost-to-charge ratios adjusted to 2017 US dollars for inpatients with stroke by ventilation status (no IMV, IMV alone, tracheostomy).
Results: Of an estimated 5.2 million (95% CI, 5.1-5.3) acute stroke hospitalizations, 2008 to 2017; 9.4% received IMV alone and 1.4% received tracheostomy. Length of stay for patients without IMV was shorter (median, 4 days; interquartile range [IQR], 2-6) compared with IMV alone (median, 6 days; [IQR, 2-13]), and tracheostomy (median, 25 days; [IQR, 18-36]; <0.001). Mortality for patients without IMV was 3.2% compared with 51.2% for IMV alone and 9.8% for tracheostomy (<0.001). Median hospitalization costs for patients without IMV was $9503 (IQR, $6544-$14 963), compared with $23 774 (IQR, $10 900-$47 735) for IMV alone and $95 380 (IQR, $63 921-$144 019) for tracheostomy. Tracheostomy placement in ≤7 days had lower costs compared with placement in >7 days (median, $71 470 [IQR, $47 863-$108 250] versus $102 979 [IQR, $69 563-$152 543]; <0.001). Each day awaiting tracheostomy was associated with a 2.9% cost increase (95% CI, 2.6%-3.1%). US hospitalization costs for patients with acute stroke were $8.7 billion/y (95% CI, $8.5-$8.9 billion). For IMV alone, costs were $1.8 billion/y (95% CI, $1.7-$1.9 billion) and for tracheostomy $824 million/y (95% CI, $789.7-$858.3 million).
Conclusions: Patients with acute stroke who undergo tracheostomy account for 1.4% of stroke admissions and 9.5% of US stroke hospitalization costs. Future research should focus on the added value to society and patients of IMV and tracheostomy, in particular after 7 days for the latter procedure given the increased costs incurred and poor outcomes in stroke.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1161/STROKEAHA.123.043176 | DOI Listing |
PLoS One
November 2024
Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Introduction: Invasive mechanical ventilation (IMV) is frequently used as a life-supporting device in Pediatric Intensive Care Units (PICU). To date, there are few studies evaluating the impact of prolonged mechanical ventilation (PMV) in children which is associated with high morbidity and mortality. We aimed to determine the incidence and factors associated with PMV in PICU at our institution.
View Article and Find Full Text PDFRespiration
October 2024
Department of Pneumology and Critical Care Medicine, Thoraxklinik University Hospital Heidelberg, Heidelberg, Germany,
Background: Established structured weaning approaches, which are effective for patients in simple and difficult weaning, are often not appropriate for patients undergoing prolonged weaning. Addressing the complexity of weaning failure requires personalized precision medicine. The therapeutic concept of treatable traits (TTs) has been proposed as a new paradigm for the management of chronic respiratory diseases.
View Article and Find Full Text PDFBMC Pulm Med
September 2024
Department of Anesthesiology and Intensive Care, Turku University Hospital and University of Turku, Turku, Finland.
Pediatrics
September 2024
University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota.
Andes Pediatr
June 2024
Universidad de Chile, Santiago, Chile.
Unlabelled: Congenital Central Hypoventilation Syndrome (CCHS) is a rare genetic condition affecting the autonomic nervous system and respiratory center due to mutations in the PHOX2B gene, and it is associated with alveolar hypoventilation during sleep and sudden death. It requires early invasive mechanical ventilation (IMV).
Objective: To report a neonatal case successfully treated with non-invasive ventilatory support (NVS), avoiding tracheostomy.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!