The impact of adverse patient occurrences on hospital costs in the pediatric intensive care unit

OBJECTIVES: To study the influence of adverse patient occurrences defined as airway complication (AC), vascular complication (VC), and infectious complication (IC) on intensive care unit (ICU) costs and length of stay (LOS). DESIGN: Retrospective, cohort study SETTING: An urban, tertiary care children's hospital in Philadelphia, PA. PATIENTS: All children admitted to a multidisciplinary pediatric ICU during the fiscal year 1994. INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: Demographic data, diagnoses, Pediatric Risk of Mortality scores, LOS, and deaths were recorded. Hospital charges were converted into costs by using cost-to-charge ratios. There were 23 AC, 35 VC, and 40 IC events. Multiple regression in models adjusting for age, Pediatric Risk of Mortality score, mortality, chronic disease, and diagnosis by using AC, VC, and IC indicator variables was performed on the dependent variables of LOS and total costs. IC was associated with an increase in total costs of 50, 361. 89 (p <. 001), an increased LOS of 15. 6 days (p <. 001), and no significant increase in daily costs. There were no significant increases in costs or LOS seen with the AC and VC variables. In a matched analysis, the total costs attributable to IC averaged 32, 040 per patient. CONCLUSIONS: The occurrence of complications in the pediatric ICU is associated with meaningful increases in LOS and hospital costs. ICs are more important predictors of costs than ACs or VCs. Continuing efforts should be made to minimize adverse occurrences to improve patient care and reduce costs.