• Jessica A Schults, Lisa Hall, Karina R Charles, Claire M Rickard, Renate Le Marsney, Endrias Ergetu, Alex Gregg, Joshua Byrnes, Sarfaraz Rahiman, Debbie Long, Anna Lake, and Kristen Gibbons.
• School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.
• Pediatr Crit Care Me. 2024 Dec 18.

ObjectivesTo identify the health and economic costs of hospital-acquired complications (HACs) in children who require PICU admission.DesignPropensity score matched cohort study analyzing routinely collected medical and costing data collected by the health service over 6 years (2015-2020).SettingTertiary referral PICU in Queensland, Australia.PatientsAll children admitted to the PICU were included.InterventionsNone.Measurements And Main ResultsWe assessed ventilator- and respiratory support-free days at 30 days post-PICU admission, length of PICU stay, prevalence of individual HACs, and attributable healthcare costs. A total of 8437 admissions, representing 6054 unique patients were included in the analysis. Median (interquartile range) for cohort age was 2.1 years (0.4-7.7 yr), 56% were male. Healthcare-associated infections contributed the largest proportion of HACs (incidence rate per 100 bed days, 46.5; 95% CI, 29.5-47.9). In the propensity score matched analyses (total 3852; 1306 HAC and 1371 no HAC), HAC events were associated with reduced ventilator- (adjusted subhazard ratio [aSHR], 0.88 [95% CI, 0.82-0.94]) and respiratory support-free days (aSHR, 0.74 [95% CI, 0.69-0.79]) and increased PICU length of stay (aSHR, 0.63 [95% CI, 0.58-0.68]). Healthcare costs for children who developed a HAC were higher compared with children with no HAC, with mean additional cost ranging from Australian dollar (A$) 77,825 (one HAC [95% CI, $57,501-98,150]) to $310,877 (≥ 4 HACs [95% CI, $214,572-407,181]; in 2022, the average conversion of A$ to U.S. dollar was 0.74).ConclusionsIn our PICU (2015-2020), the burden of HAC for critically ill children was highest for healthcare-associated infections. Further high-quality evidence regarding HAC prevention and prospective risk assessment could lead to improved patient outcomes and reduced costs.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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