Introduction: Rates of external ventricular drain (EVD)-associated infections range broadly in the literature, from 1 - 40%. Nonetheless, ventriculostomy-associated infections (VAIs) are a significant cause of morbidity and portends an overall poor prognosis. VAIs have been correlated with increased length of hospital stay, and a longer time requiring intensive care. Given the worse clinical outcomes and the greater use of hospital resources, we hypothesize that patients with VAIs have overall greater health care costs, compared to non-infected patients.
Methods: Patients who underwent EVD placement at Mount Sinai Hospital between December 2010 and January 2016 were included in the study. Clinical records were retrospectively reviewed from the hospital’s electronic medical record, and healthcare cost data was obtained from the hospital’s finance department. Clinical information included demographics, details from the hospital course, and outcomes. Total costs, as well as direct/indirect and fixed/variable costs, were analyzed for every patient.
Results: Over the 6-year study period, 246 EVDs were placed in 243 patients, with an infection rate of 9.9% (n=24). The median duration of external ventricular drainage for infected compared to non-infected patients was 19 and 9 days, respectively (p<0.0001). Median length of intensive care unit stay was also increased for patients with VAI (30 days), compared to non-infected patients (13 days). Total healthcare costs were significantly increased for infected versus non-infected patients (US$ 168,629 versus US$ 83, 919, p<0.0001). This trend was comparable for all other cost subtypes including fixed-direct (US$ 9,973 vs. US$ 5,079, p<0.001), fixed-indirect (US$ 74,473 vs. US$ 36,277, p<0.001), variable-direct (US$ 76,700 vs. US$ 36,870, p<0.001), and variable-indirect (US$ 8,898 vs. US$ 4,653, p<0.001). The percentage cost increases were 96%, 105%, 108%, and 91%, respectively.
Conclusions: The complication of a ventricular catheter-associated infection led to significantly increased overall healthcare costs, by approximately double. This takes into account direct costs of the healthcare system, as well as the indirect costs associated with morbidity and loss of productivity. Moving forward, prevention of ventriculostomy-associated infections remains of utmost importance to limit undue strain on the neurosurgical healthcare financial system.
Patient Care: By identifying the significant costs associated with ventriculostomy-associated infections, further measures should be enacted to better prevent this potentially avoidable complication.
Learning Objectives: Quantify the financial burden of ventriculostomy catheter-associated infections, including direct and indirect healthcare costs.