Comparison of hospital length of stay, costs, and readmissions of alteplase versus catheter replacement among patients with occluded central venous catheters.
J Hosp Med. 2014 May 14;
Authors: Ernst FR, Chen E, Lipkin C, Tayama D, Amin AN
BACKGROUND: Central venous catheter (CVC) occlusion is common, affecting 30% of all CVCs.
OBJECTIVE: To compare length of stay (LOS), costs, and readmissions associated with the use of alteplase to clear catheter blockage to outcomes associated with catheter replacement.
DESIGN: Retrospective observational study utilizing a large hospital database.
PARTICIPANTS: Hospitalized patients treated for catheter occlusion from January 2006 to December 2011.
MAIN MEASURES: Univariate analyses of patient characteristics and treatment patterns and multivariable regression analyses of postocclusion hospital costs, LOS, and 30- and 90-day readmissions were conducted.
KEY RESULTS: We included 34,579 patients treated for a CVC occlusion by replacement (N = 1028) or by alteplase (2 mg) administration (N = 33,551). Patients receiving alteplase were somewhat younger than those having catheter replacement (60 ± 19 vs 62 ± 20 years old, P = 0.0002). After adjusting for patient and hospital factors via regression modeling, average daily postocclusion costs were $317 lower for alteplase recipients than for catheter replacement patients (95% confidence interval [CI]: 238.22-392.24; P < 0.0001). Adjusted total postocclusion costs were $1419 lower for alteplase recipients versus patients receiving catheter replacement (95% CI: 307.27-2458.12; P = 0.0121). Postocclusion operating room/surgery, radiology, and supply costs were significantly lower for alteplase recipients (P < 0.001). Average adjusted postocclusion LOS was similar for both groups (P > 0.05). Odds of readmission were not significantly different at 30 or 90 days.
CONCLUSIONS: Among patients treated for an occluded CVC, alteplase-treated patients had lower daily and total postocclusion costs than patients receiving catheter replacement. Cost differences were mainly driven by lower operating room/surgery, radiology, and supplier costs. Journal of Hospital Medicine 2014. © 2014 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine.
PMID: 24825837 [PubMed - as supplied by publisher]