Risk factors for long-term invasive mechanical ventilation: a longitudinal study using German health claims data

Abstract

Background: Long-term invasive mechanical ventilation (IMV) is a major burden for those affected and causes high costs for the health care system. Early risk assessment is a prerequisite for the best possible support of high-risk patients during the weaning process. We aimed to identify risk factors for long-term IMV within 96 h (h) after the onset of IMV.

Methods: The analysis was based on data from one of Germany's largest statutory health insurance funds; patients who received IMV ≥ 96 h and were admitted in January 2015 at the earliest and discharged in December 2017 at the latest were analysed. OPS and ICD codes of IMV patients were considered, including the 365 days before intubation and 30 days after discharge. Long-term IMV was defined as evidence of invasive home mechanical ventilation (HMV), IMV ≥ 500 h, or readmission with (re)prolonged ventilation.

Results: In the analysis of 7758 hospitalisations, criteria for long-term IMV were met in 38.3% of cases, of which 13.9% had evidence of HMV, 73.1% received IMV ≥ 500 h and/or 40.3% were re-hospitalised with IMV. Several independent risk factors were identified (p < 0.005 each), including pre-diagnoses such as pneumothorax (OR 2.10), acute pancreatitis (OR 2.64), eating disorders (OR 1.99) or rheumatic mitral valve disease (OR 1.89). Among ICU admissions, previous dependence on an aspirator or respirator (OR 5.13), and previous tracheostomy (OR 2.17) were particularly important, while neurosurgery (OR 2.61), early tracheostomy (OR 3.97) and treatment for severe respiratory failure such as positioning treatment (OR 2.31) and extracorporeal lung support (OR 1.80) were relevant procedures in the first 96 h after intubation.

Conclusion: This comprehensive analysis of health claims has identified several risk factors for the risk of long-term ventilation. In addition to the known clinical risks, the information obtained may help to identify patients at risk at an early stage. Trial registration The PRiVENT study was retrospectively registered at ClinicalTrials.gov (NCT05260853). Registered at March 2, 2022.

Keywords: Invasive home mechanical ventilation; Long-term invasive mechanical ventilation; Predictive model; Prognostic factors; Prolonged weaning; Weaning; Weaning failure.

Fig. 1

Overview of the time periods of predictors and outcomes. The analysis was based on data from the AOK Baden-Württemberg; patients who received IMV ≥ 96 h and were discharged between 2015 and 2017 were analysed. Health claims data were considered, in each case for the previous year and 30 days after hospitalisation. Abbreviations: OPS official classification of operational procedures in Germany

Fig. 2

Consort diagram of inclusions and exclusions

Fig. 3

Identified risk factors for long-term invasive mechanical ventilation. The figure shows all predictors of the model with their respective odds ratios and confidence intervals. In addition to stem data (black dots), pre-existing conditions coded in the 365 days prior to the index case (red dots), admission diagnosis (green dots), pre-existing conditions, admission diagnosis in the last 365 days (blue dots), operations and procedures prior to the index stay from the same period (turquoise dots) and operations and procedures during the hospital stay up to 95 h after intubation (pink dots) were considered. COPD chronic obstructive pulmonary disease, CSF cerebrospinal fluid, CT computed tomography, MRI magnetic resonance imaging. Extracorporeal life support includes pumpless extracorporeal lung assist, extracorporeal CO2 removal, veno-venous and veno-arterial, ECMO extracorporeal membrane oxygenation

Fig. 4

Receiver operating characteristic (ROC) curves for training and test data. The figure shows the ROC curves of the model for the training data set (red) and the test data set (blue). ROC receiver operating characteristic, AUC area under the curve