To evaluate institutional cost of community-acquired CLABSI in pediatric HPN patients” Raphael et al (2018).
BACKGROUND: While previous literature suggests home parenteral nutrition (HPN) dependent children experience frequent complications like community acquired central line associated bloodstream infections (CLABSI), few studies have characterized the cost.
OBJECTIVES: To evaluate institutional cost of community-acquired CLABSI in pediatric HPN patients.
METHODS: This is a single center retrospective review of institutional costs for HPN patients with community-acquired CLABSI at a tertiary care children’s hospital. Inclusions were age ≤ 18 years-old between October 2011 to April 2016. Exclusions were death during hospitalization, readmission within 2 days of discharge. Patient-level factors were compared between high-cost group and all others using Welch’s two-sample t-test and ANOVA. Multivariable logistic regression was used to determine predictors of higher cost.
RESULTS: There were 176 CLABSI admissions among 68 patients over the study period (median 2 hospitalizations per patients). The mean cost and length of stay (LOS) per hospital admission are $28,375 (2015 US dollars) and 8 days, and both were associated with intensive care unit admission (ICU), central venous catheter (CVC) removal, private insurance, and age < 2 at admission. Nine percent of patients were classified as “super-utilizers” whose 54 hospitalizations accounted for 28% of total institutional costs.
CONCLUSIONS: Among pediatric HPN patients, community-acquired CLABSI is associated with significant cost and LOS. Healthcare utilization is disproportionately concentrated in a small number of patients. These study findings may help inform cost analysis for future CLABSI prevention strategies.
Raphael, B.P., Hazekamp, C., Samnaliev, M. and Ozonoff, A. (2018) Analysis of Healthcare Institutional Costs of Pediatric Home Parenteral Nutrition Central Line Infections. Journal of Pediatric Gastroenterology and Nutrition. June 13th.