Vascular access for patients with history of injection drug use
Abstract:
Background and Aim: Patients with history of injection drug use (IDU) and a vascular access device (VAD) placement during hospitalization may cause concern of VAD misuse or contamination. In this study, we evaluated mean hospital length of stay (LOS), hospitalization cost, and rate of potentially preventable catheter related infections (PPCRIs) for IDU and non-IDU patients with VADs.
Methods: In this retrospective cohort study, we used the US Premier Healthcare Database claims data from 2019 and 2020. Inpatient admissions (age >10 years) with recorded VAD placement were assigned to 2 cohorts, those with and without a recorded use of prescribed drug treatments for IDU (VAD + IDU and VAD-only cohorts, respectively). Patients with IDU but without VAD served as a control cohort.
Results: Data from 491,406 patients were analyzed. The rate of IDU among those who received a VAD placement was 3%. Patients identified as VAD + IDU were younger and had a lower Charlson Comorbidity Index than the VAD-only population. The VAD + IDU patients had a mean LOS that was 1.8 times longer and mean cost of care that was 1.9 times higher for all-cause admissions. The ratio of observed/expected PPCRI events increased in 2020 in the VAD + IDU but not in the VAD-only population.
Conclusions: Compared with patients without IDU, the patients with VAD + IDU in this study had overall longer LOS, higher inpatient cost, and a higher rate of PPCRI during the height of the pandemic. Cost-effective strategies to mitigate the complications and problems associated with receiving care and tampering with VADs are imperative.
Reference:
Laura Soloway, Tarja Kärpänen; Length of Stay, Hospitalization Cost, and Infection Rate for Inpatients With Vascular Access Devices With and Without History of Injection Drug Use. Journal of the Association for Vascular Access 1 December 2023; 28 (4): 23–30. doi: https://doi.org/10.2309/JAVA-D-23-00015.