SAN FRANCISCO — Neonates with respiratory distress syndrome treated with non-invasive ventilation had lower healthcare costs and shorter length of stay compared to those who were intubated, according to study findings presented at the 2016 AAP National Conference and Exhibition.
“The use of non-invasive ventilation has increased in neonates with respiratory distress syndrome. However, information on non-invasive ventilation and resource utilization is limited,” Thomas Chavez, from the division of neonatology at Children’s Hospital Los Angeles, and colleagues wrote.
Chavez and colleagues gathered data every three years from 1997 to 2012 from the National Healthcare Cost and Utilization KID database to determine the national incidence rate of non-invasive ventilation and endotracheal intubation use in neonates with respiratory distress syndrome, as well as the predictors of endotracheal intubation, length of stay and group average costs. They used ICD-9-CM codes to determine procedure and diagnosis codes.
The researchers identified 595,254 neonates with respiratory distress syndrome, of whom 12% were treated with only non-invasive ventilation, and 51% were intubated. Results showed that use of non-invasive ventilation significantly increased yearly from 6% in 1997 to 17% in 2012. In addition, patients receiving non-invasive ventilation had significantly lower length of stay and costs in comparison to those receiving endotracheal intubation.
Analysis adjusted for multivariates — such as health insurance, sex, prematurity and race — revealed that patients had reduced chances of endotracheal intubation if they were treated with non-invasive ventilation (aOR [95% CI], 0.86 [0.85, 0.87]). Chavez and colleagues matched neonates 1:1 based on sex, race, health insurance, year of discharge, prematurity and diagnosis of infections, such as sepsis, patent ductus arteriosus, apnea and bradycardia. Compared to their matched counterparts who underwent endotracheal intubation, neonates in the non-invasive ventilation group had a shorter length of stay (n = 38,911 pairs: [95% CI] 25 [5.3, 25.7] vs. 33 [32.9, 33.6]) and reduced group average costs (n = 29,836 pairs: [$/1k] [95% CI] 46.1 [45.5, 46.8] vs. 64.1 [63.2, 65.0]).
Overall, non-invasive ventilation use saved $546 million in healthcare costs. “Non-invasive ventilation was associated with decreased per patient LOS and costs compared to intubated patients and decreased odds of endotracheal intubation,” Chavez and colleagues concluded. – by Alaina Tedesco
Chavez T, et al. Presented at: AAP National Conference and Exhibition; Oct. 22-25, 2016; San Francisco, California.
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