The association between non-ventilator associated hospital acquired pneumonia and patient outcomes among U.S. Veterans

• Published in: American journal of infection control Vol. 50; no. 12; pp. 1339 - 1345
• Main Authors: Carey, Evan, Chen, Hung-Yuan P., Baker, Dian, Blankenhorn, Richard, Vega, Ryan J., Ho, Michael, Munro, Shannon
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2022
• Subjects: Cost; Healthcare-Associated Pneumonia; Humans; Mortality; Non-device related pneumonia; Non-ventilator associated hospital acquired pneumonia; Pneumonia - epidemiology; Pneumonia, Ventilator-Associated - prevention & control; Retrospective Studies; Risk Factors; Risk stratification; Sepsis; Veterans; Non-ventilator associated hospital acquired pneumonia; Non-device related pneumonia; Veterans; Cost; Mortality; Risk stratification
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2022.02.023

•NV-HAP leads to longer length of stay and higher mortality and health care costs.•Data available at admission is insufficient for risk stratification.•Approximately 20% of all sepsis cases were associated with NV-HAP.•Evidence-based prevention efforts should target all hospitalized patients. Non-ventilator associated hospital acquired pneumonia (NV-HAP) affects approximately 1 in 100 hospitalized patients yet risk-adjusted outcomes associated with developing NV-HAP are unknown. Retrospective cohort study with propensity score matched populations (NV-HAP vs no NV-HAP), using ICD-10 codes for bacterial pneumonia not present on admission. Outcomes included the patient level probability of NV-HAP developing among acute care non-transfer admissions in 133 Veterans Affairs hospitals and subsequent mortality, length of stay, inpatient sepsis, and 12-month costs. NV-HAP occurred in 0.6% of Veteran admissions. Among admissions that developed NV-HAP, the mean length of stay of 26.3 days (6.72 days among non-NV-HAP), 30-day mortality was 18.4% (4.5% among non-NV-HAP), 1-year mortality was 47.8% (21.4% among non-NV-HAP), and total median 12-month direct medical costs were $138,136.32 ($64,357.21 among non-NV-HAP). Inpatient sepsis occurred in approximately 20% of NV-HAP admissions (0.7% among non-NV-HAP). Data available at admission was insufficient to identify high and low risk patient groups. NV-HAP is associated with severely worse patient outcomes and increased costs of care up to 12 months post-episode. Since population risk stratification is not feasible, prevention efforts should be directed at the full population of hospitalized Veterans.