e23095 Background: Mechanical ventilation (MV) during cancer hospitalizations is commonly evaluated as a binary event, potentially obscuring heterogeneity in escalation trajectories. The association between length-of-stay–based MV timing categories and distinct inpatient patterns of severity and resource intensity among hospitalized adults with malignancy was examined. Methods: We performed a serial cross-sectional analysis of adult hospitalizations with a principal diagnosis of malignancy in the 2018–2022 Healthcare Cost and Utilization Project National Inpatient Sample. MV was identified using ICD-10-PCS procedure codes and categorized as no MV, early MV (LOS ≤3 days), intermediate MV (LOS 4–9 days), or late MV (LOS ≥10 days) as an administrative timing proxy. Outcomes included in-hospital mortality (primary), shock and dialysis-requiring acute kidney injury as escalation-associated endpoints, LOS, hospitalization cost derived using cost-to-charge ratios, and APR-DRG severity of illness subclass. National estimates were generated using survey-weighted analyses incorporating discharge weights with hospital-level clustering and stratification. Results: Among an estimated 4, 809, 239 cancer hospitalizations nationally, MV occurred in 2. 6% of admissions, distributed as 0. 31% early MV, 0. 70% intermediate MV, and 1. 58% late MV. Mortality differed markedly by MV timing: 3. 40% among non-ventilated admissions versus 66. 65% for early MV, 42. 80% for intermediate MV, and 35. 47% for late MV. Early MV corresponded to a rapid escalation trajectory with very short LOS (1. 84 days), high APR-DRG severity (3. 74), and high shock prevalence (25. 36%). Intermediate MV admissions had LOS similar to non-ventilated admissions (6. 53 vs 6. 52 days) but substantially higher mortality (42. 80% vs 3. 40%), higher shock prevalence (17. 82%), and higher mean costs (42, 394 vs 28, 448). Late MV corresponded to prolonged critical illness with extreme resource utilization, including LOS of 25. 89 days and mean cost of 132, 530; late MV admissions had the highest dialysis-requiring acute kidney injury prevalence (10. 25%) and the highest APR-DRG severity (3. 89). Conclusions: LOS-defined MV timing categories group adult cancer hospitalizations into distinct escalation-associated trajectories with large differences in mortality, severity, and resource intensity. Timing-based MV gives an insight into cancer patients’ hospital course and will aid in future research into prognosis of hospitalized cancer patients.
Nichols et al. (Thu,) studied this question.