V ENTILATOR-ASSOCIATED PNEUMONIA (VAP) is a potentially costly complication for any patient requiring mechanical ventilation. The incidence of VAP is significantly higher in sur- gical intensive care units (ICUs) than medical ICUs from data compiled by the National SURGICAL INFECTIONS Volume 6, Number 1, 2005 © Mary Ann Liebert, Inc. Cost of a Ventilator-Associated Pneumonia in a Shock Trauma Intensive Care Unit CHRISTINE S. COCANOUR, 1 LUIS OSTROSKY-ZEICHNER, 1,2 MICHELLE PENINGER, 2 DEBBI GARBADE, 2 TOMMY TIDEMANN, 2 BRADLEY D. DOMONOSKE, 2 TAO LI, 2 STEVEN J. ALLEN, 2 and KATHARINE M. LUTHER 2 ABSTRACT Background: Nosocomial pneumonia and especially ventilator-associated pneumonia (VAP) are costly complications for the hospitalized patient. Nosocomial pneumonia has been esti- mated to cost $5,000 per episode, but the specific cost for a VAP has not been well estimated. As part of a successful performance improvement program in decreasing VAP from 10 VAPs/100 ICU admissions to 2.5 VAPs/100 ICU admissions, we examined the costs associated with VAP. Methods: From January 1, 2002, through September 30, 2003, Shock Trauma Intensive Care Unit patients and charts were reviewed concurrently by an infection control practitioner for development of VAP as defined by National Nosocomial Infection Surveillance (NNIS) guide- lines. Costs were obtained from the hospital’s cost accounting software Transition Systems version 3.1.01 (TSI). All patients requiring greater than one day of mechanical ventilation were evaluated. Seventy patients with VAP and 70 patients without VAP were matched according to age and Injury Severity Score. Differences were compared using Kruskal-Wallis and two- sample T-tests. Significance was considered for p  0.05. Results: The ICU cost difference was significant (p  0.05) between the case-controlled pa- tients with VAP ($82,195) and those without VAP ($25,037). There was also a significant in- crease in ICU length of stay (21.6 versus 6.4 days) and the number of ventilator days (17.7 ver- sus 5.8; both, p  0.05). Mortality was not different in the case-controlled population. A substantial portion of the increased cost of a VAP was from the increase in ICU length of stay ($1,861/day). Pharmacy, respiratory and “other” also accounted for the increases when cost distribution was analyzed. This translates into a cost avoidance of approximately $428,685 per 100 admissions to the ICU. Conclusions: Ventilator-associated pneumonia not only leads to a significant increase in ventilator days and ICU length of stay, but adds substantially to hospital costs. In our ICU, an episode of VAP costs $57,000 per occurrence. 1 University of Texas Health Science Center at Houston, Houston, Texas. 2 Memorial Hermann Hospital, Houston, Texas. Presented at the 24 th Annual Meeting of the Surgical Infection Society, Indianapolis, Indiana, April 29, 2004. 65