ECONOMIC-IMPACT OF PROLONGED MOTOR WEAKNESS COMPLICATING NEUROMUSCULAR BLOCKADE IN THE INTENSIVE-CARE UNIT

Objective: We compared a case-series of ten patients who developed pro longed neuromuscular weakness after continuous, nondepolarizing, neuro muscular blockade with a group of controls without neuromuscular weakn ess to determine the economic impact of the neuromuscular weakness. De sign: Frequency-matched case control trial. Setting: Medical and surgi cal intensive care units of a 937-bed tertiary care, university-affili ated teaching hospital. Patients: Ten patients developed prolonged neu romuscular weakness after continuous administration of nondepolarizing neuromuscular blockers. Ten patients from a 1994 drug utilization dat abase who did not develop motor weakness after paralysis were identifi ed to serve as controls. Measurements and Main Results: The medical an d accounting records of the patients were retrospectively reviewed. Ch arge data were obtained from patient accounts. Institutional ratios to convert charges to full costs and marginal costs were obtained from t he Hospital Finance Department of Henry Ford Hospital. The economic im pact of the diagnosis and recovery of the motor weakness was estimated for the intensive care unit (ICU) and hospital stays and compared wit h those values for control patients. Median hospital charges (excludin g rehabilitation), totaling $91,476, were attributed to the patients w ho developed neuromuscular weakness and included charges for neuromusc ular blocking agents, continuous mechanical ventilation, ICU and hospi tal beds, neurologic studies, and physical therapy services. In the co ntrol patients, median charges were $22,191 (p = .001). The total medi an cost differential for a patient in the neuromuscular weakness group was in excess of $66,713 (95% confidence interval $23,485 to $189,214 , p = .001). Significant differences were also found for patient charg es, full costs, and marginal costs for mechanical ventilation (p = .00 2), neurologic studies (p = .014), as well as ICU (p = .002) and hospi tal (p = .001) stays. Conclusions: The development of motor weakness w as associated with an increase in ICU and hospital stays, continued me chanical ventilation, and disproportionate healthcare expenditures in excess of $66,000 per patient. A prospective evaluation of the true pr evalence of neuromuscular weakness after neuromuscular blockade and of the costs to the healthcare system is needed.