Date of Award


Document Type

Campus Access Dissertation


Health Services and Policy Management

First Advisor

Sudha Xirasagar


Ventilator Associated Pneumonia (VAP) is a major hospital-acquired infection in acute care settings, and its consequences are significant. VAP is considered a preventable infection if the risk factors are managed effectively in predisposed patients, and if the associated cost and mortality are well understood. The purpose of this study is to assess the risk factors for VAP cases and to estimate the cost and mortality associated with VAP.

This study used NIS discharge data extracted from the HCUP database. The study sample consists of all 265,760 mechanically ventilated (MV) patients without an admission diagnosis of pneumonia, discharged between October 1, 2008 and December 31, 2009. Dependent variables were having VAP, hospital mortality, and total inpatient cost. Weighted logistic regression with stepwise variable selection was used to identify the VAP risk factors and the risk factors for hospital mortality. Quantile regression was used to compute precise estimates of the impact of VAP and admission source on inpatient (IP) care costs of MV patients at 10th, 25th, 50th, 75th, 90th, 95th, and 99th percentiles. Among the total MV study sample, there were 4,436 patients (1.64%) with VAP, and 28.04% of all MV patients died in hospital. Independent risk factors for VAP are age, nutrition deficiency, intracranial injury, tracheostomy, bronchoscopy, UTI, MV of 96 hours or more, extreme clinical severity, transfer from another acute care hospital, small hospitals, and teaching hospital. VAP patients were less likely to die in hospital, both crude and adjusted odds showing similar results. VAP added significantly to the total cost of care at all cost percentiles studied (p<0.001). At the median IP cost level, the adjusted VAP-associated excess cost was $6,289 (p<0.01; 23 % of the median total IP cost).

In conclusion, our study suggests the need for vigorous attention to consistent implementation of the MV bundle, and when possible, use of noninvasive ventilator support on the first day of MV, which could result in substantial decrease in VAP rate and the associated consequences.


© 2012, Hasan A. Areabi