Unplanned extubations in children: Impact on hospital cost and length of stay

Dantin J. Roddy, Michael C. Spaeder, William Pastor, David C. Stockwell, Darren Klugman

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Objective: To determine the attributable hospital cost, both operational and departmental, and length of stay associated with unplanned extubations in children admitted to PICU and cardiac ICU. Design: Retrospective, matched case-control study. Setting: Forty-four-bed PICU and 26-bed cardiac ICU in a 303-bed tertiary care pediatric hospital. Patients: Cases with an unplanned extubation were retrospectively identified from July 2011 to March 2013. Controls were PICU and cardiac ICU patients admitted over the same time period and were matched at a ratio of 2:1 for age and diagnosis. Interventions: None. Measurements and Main Results: Forty-eight unplanned extubations were analyzed. There were no differences in patient demographics between the two groups, except the control group had a higher severity of illness as illustrated by a larger Paediatric Index of Mortality II Risk of Mortality. Median total hospital costs were higher in those patients with unplanned extubations as compared with controls ($101,310 vs $64,618; p < 0.001). Patients with an unplanned extubation had longer median ICU length of stay (10 d vs 4.5 d; p < 0.001) and hospital length of stay (16.5 d vs 10 d, p < 0.001). Conclusion: Pediatric patients with unplanned extubations have an associated increase in hospital costs ($36,692/case) and length of stay (6.5 d/case) as compared with age and diagnosis-matched controls. Further efforts are warranted to establish data-driven benchmarks and establishment of unplanned extubations as a critical metric for ICU quality.

Original languageEnglish (US)
Pages (from-to)572-575
Number of pages4
JournalPediatric Critical Care Medicine
Issue number6
StatePublished - Jul 22 2015
Externally publishedYes


  • endotracheal extubation
  • hospital costs
  • intensive care units
  • length of stay
  • pediatrics
  • quality improvement

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine


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