Hospitalizations with ventilator-associated pneumonia have increased over time

NASHVILLE, Tenn. — Hospitalization with ventilator-associated pneumonia increased 50% between 2013 and 2019, according to a study presented at CHEST Annual Meeting.

“Health care-associated infections are a significant burden on patient outcomes, and that’s one of the most important adverse events when it comes to patient safety,” Namratha Seetharam Meda, MBBS, resident physician at MedStar Health—Georgetown/Washington Hospital Center, said during her presentation. “An important contributor to that is ventilator-associated pneumonia, which develops at least 48 hours after requiring mechanical ventilation.”

In critically ill patients, ventilator-associated pneumonia (VAP) can impact outcomes such as mortality, length of stay and cost of care, Meda added.

In the current analysis, Meda and colleagues sought to evaluate trends in VAP across the nation using 2013 to 2019 hospitalization data from the National Inpatient Sample.

Researchers identified 128,025 adult hospitalizations (mean age, 58 years; 36.5% women) with VAP, with a “consistently increasing trend” observed overall and among men and women, Meda said. Specifically, researchers observed a 50% increase in hospitalizations with VAP, from 50 per 100,000 hospitalizations in 2013 to 75 per 100,000 hospitalizations in 2019.

Of these, 42,120 hospitalizations were associated with tracheostomy, ventilator dependence, or both, with an 80% increase in this subset, from 15 per 100,000 hospitalizations in 2013 to 27 per 100,000 in 2019.

Of all the hospitalizations, median length of stay was 20 days (interquartile range [IQR], 11-34), with a median cost of $83,311 (IQR, $41,106-$149,913), and a 20.08% rate of all-cause in-hospital mortality. Meda noted there were no significant changes from 2013 to 2019 in median cost or mortality rates, although median costs were significantly higher in the event of in-hospital mortality ($88,494 vs. $81,993; P < .001).

The estimated annual cost of all VAP-related hospitalizations reached $2.8 billion in 2019, researchers found.

Results also showed that men had longer median length of stay (21 days vs. 19 days) and higher median costs ($87,981 vs. $74,889; P < .001 for both) than women.

“Despite advances in health care and patient safety protocols, there still has been an increasing trend of VAP-related hospitalizations, however without a significant change in mortality,” Meda said. “Could we speculate that this is because of the increasing number of tracheostomies and ventilator dependence that we’ve been seeing? Or is it because of our advances that we can better detect more of these VAP incidences amongst our patients? This definitely warrants further study to look into individual factors affecting this trend.”

Reference:

Patel HB, et al. Chest. 2022;doi:10.1016/j.chest.2022.08.570.