D25-21 The Cost of Survival After ARDS: A Nationwide Analysis of Six-Month Readmissions and Economic Burden

Abstract Rationale Short-term survival among patients with acute respiratory distress syndrome (ARDS) has improved; however, the post-discharge phase remains poorly characterized. Survivors often face prolonged recovery with physical, cognitive, and psychological sequelae that drive recurrent hospitalizations and increased healthcare costs. Understanding the economic trajectory of ARDS survivors is vital to guide post-ICU care and resource allocation. Methods Using the 2022 Nationwide Readmissions Database, we identified adults (≥18 years) with ARDS (ICD-10-CM J80) who survived their index hospitalization in the first quarter of 2022. Patients who died during the index admission were excluded. Survey-weighted analyses accounted for the complex sampling design and provided national estimates of 30-, 90-, and 180-day readmissions and cumulative readmission-related costs (excluding index costs). Predictors of cost included discharge disposition and the use of advanced organ support during the index stay—veno-venous extracorporeal membrane oxygenation (VV-ECMO), tracheostomy, and continuous renal replacement therapy (CRRT). Results Among 11, 189 ARDS survivors from the first quarter of 2022 (mean age 57. 1 years; 44. 1% female), readmission rates were 5. 0% at 30 days, 17. 1% at 90 days, and 24. 7% at 180 days. National estimates indicated that approximately 5, 197 survivors were readmitted within six months of discharge. Patients discharged to post-acute facilities had higher six-month readmission rates than those discharged home (26. 7% vs. 19. 5%) but lower average readmission costs (190, 117 vs. 208, 853). This pattern suggests that patients discharged to facilities often return with less severe conditions or for rehabilitation, whereas those discharged home tend to have fewer but more serious or acute readmissions. The mean cumulative readmission cost per patient was 456, 424, which included 14. 9 extra hospital days within six months. Nationwide, this amounted to an estimated 600 million in hospitalization costs over the six-month post-discharge period. Advanced organ support during the index hospitalization markedly increased subsequent costs: ECMO by 130% (436, 067 vs. 189, 844), tracheostomy by 24% (234, 286 vs. 189, 184), and CRRT by 22% (232, 974 vs. 190, 898). Conclusions our study show that surviving ARDS marks the beginning of a resource-intensive recovery characterized by frequent readmissions and substantial post-discharge costs. Patients discharged to facilities were more often readmitted for lower-cost, less severe conditions, whereas those discharged home experienced fewer but costlier and more serious readmissions. The highest burden occurred among patients requiring advanced organ support. Recognizing ARDS survivorship as a continuum of chronic critical illness and implementing structured post-ICU care, early follow-up, and individualized discharge planning may mitigate this hidden economic burden. This abstract is funded by: None