Kidney Week

Abstract: PO1964

Factors Associated with High-Cost Hospitalizations for Hemodialysis Catheter-Associated Blood Stream Infections in Children

Session Information

• Pediatric Nephrology: AKI, Dialysis, Transplant, CKD, and Nephrotic Syndrome
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1700 Pediatric Nephrology

Authors

• Wasik, Heather L., State University of New York Upstate Medical University, Syracuse, New York, United States

Heather L. Wasik, MD

• Neu, Alicia, Johns Hopkins University, Baltimore, Maryland, United States

Alicia Neu,

• Warady, Bradley A., Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States

Bradley A. Warady,

• Crawford, Brendan, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States

Brendan Crawford,

• Richardson, Troy, Children's Hospital Association, Overland Park, Kansas, United States

Troy Richardson,

• De Souza, Heidi G., Children's Hospital Association, Overland Park, Kansas, United States

Heidi G. De Souza,

• Cardwell, Diana, Children's Health Children's Medical Center Dallas, Dallas, Texas, United States

Diana Cardwell,

• Ruebner, Rebecca, Johns Hopkins University, Baltimore, Maryland, United States

Rebecca Ruebner,

Group or Team Name

• The Standardized Care to Improve Outcomes in Pediatric End Stage Kidney Disease (SCOPE) collaborative

Background

Hospitalizations of adults for hemodialysis catheter-associated blood stream infections (HD-BSI) lead to high costs. No studies have evaluated hospitalization costs for HD-BSI in children or identified factors associated with high-costs.

Methods

The Standardized Care to Improve Outcomes in Pediatric End-Stage Kidney Disease (SCOPE) collaborative database was used to identify HD-BSI. SCOPE database linked to the Pediatric Health Information Systems (PHIS) database which provided hospitalization billing data. High-cost hospitalization defined as cost above 50^th percentile in our study population. Multivariable logistic regression used to assess the relationship between high-cost hospitalization and patient and clinical characteristics.

Results

The median(IQR) LOS for HD-BSI hospitalization was 5(3-10) days. The median(IQR) cost for HD-BSI hospitalization was $18,375($11,584-$36,266). Cost for each service line was higher in high-cost group(p<0.001)(Figure 1). High-cost HD-BSI hospitalization was associated with ICU stay, LOS, need for catheter replacement/rewiring(Table 1). ICU stay (aOR=4.84, 95% CI 1.66-14.08, p=0.004) and need for catheter procedure (aOR 6.29, 95% CI 2.76-14.35, p<0.001) remained associated with high-cost hospitalization in a multivariable model.

Conclusion

Hospitalizations of children for HD-BSI lead to high costs. Efforts to prevent HD-BSI may reduce the costs of caring for children on hemodialysis.

Figure 1

Table 1