Abstract
Abstract
Background
There is an emerging body of evidence which supports that non-ventilator hospital-acquired pneumonia (NV-HAP) contributes to prolonged hospital stays, is associated with significant patient morbidity/mortality, and occurs in approximately 0.5–1% of all hospital admissions. Pneumonia is a known risk factor for sepsis, and the Agency for Healthcare Research and Quality estimates the cost of sepsis at $20 billion (2011), with incidence increasing annually by 11.9%. Our objective was to compare incidence and cost in 2 groups of pneumonia patients with sepsis as a secondary diagnosis: patients with NV-HAP and patients admitted with pneumonia (AP).
Methods
We used the 2012 Healthcare Utilization Project (HCUP) National Inpatient Sample (NIS). The HCUP NIS is a sampling of inpatient records for a given year which includes diagnosis codes, billing information, and basic patient demographics. We identified: patients with NV-HAP (N = 133,395); and AP, randomly selected to match the NV-HAP group size. Within each group we reviewed sepsis as a secondary diagnosis.
Results
The incidence of sepsis in the NV-HAP group was 36% (N = 48,588) as compared with 0.05% (N = 2420) in the AP group. The NV-HAP group was slightly younger (mean 66.7 yrs) than the AP group (mean 68.3 yrs), with equal distribution of males vs females. NV-HAP had significantly higher length-of-stay (LOS) (13.7 vs. 12.2; P < 0.001) and total mean charges ($151,651 vs. $112,556; P < 0.001) as compared with AP. NV-HAP mortality was 23.8% (N = 11,571) as compared with 27.2% (N = 657) for AP.
Conclusion
These findings add to the emerging body of knowledge on NV-HAP as a significant healthcare issue. The combination of NV-HAP and sepsis was associated with higher costs and LOS as compared with AP patients. The higher incidence of sepsis with NV-HAP contributed to many more patient deaths as compared with AP patients.
Disclosures
K. Giuliano, Sage Products: Employee, Salary; B. Quinn, Sage Products: Grant Investigator, Grant recipient; D. Baker, Sage Products: Grant Investigator, Grant recipient