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Supplementary TablesTable S1 Procedure and DRG Codes to Identify ECMO and Invasive Mechanical Ventilation UseCode setCodeDescriptionInvasive mechanical ventilation?ICD10PCS5A1935ZRespiratory Ventilation, Less than 24 Consecutive HoursICD10PCS5A1945ZRespiratory Ventilation, 24-96 Consecutive HoursICD10PCS5A1955ZRespiratory Ventilation, Greater than 96 Consecutive HoursICD10PCS0B110F4Bypass Trachea to Cutaneous with Tracheostomy Device, Open ApproachICD10PCS0B110Z4Bypass Trachea to Cutaneous, Open ApproachICD10PCS0B114F4Bypass Trachea to Cutaneous with Tracheostomy Device, Percutaneous Endoscopic ApproachICD10PCS0B114Z4Bypass Trachea to Cutaneous, Percutaneous Endoscopic ApproachICD10PCS0B113F4Bypass Trachea to Cutaneous with Tracheostomy Device, Percutaneous ApproachICD10PCS0B113Z4Bypass Trachea to Cutaneous, Percutaneous ApproachECMO?CPT33946Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-venousCPT33947Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-arterialCPT33948Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; daily management, each day, veno-venousCPT33949Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; daily management, each day, veno-arterialCPT33952Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician;?insertion?of?peripheral?(arterial and/or venous) cannula(e),?percutaneous, 6 years and older (includes fluoroscopic guidance, when performed).CPT33954Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician;?insertion?of?peripheral?(arterial and/or venous) cannula(e),?open, 6 years and older.CPT33956Extracorporeal membrane oxygenation (ECMO)/ extracorporeal life support (ECLS) provided by physician;?insertion?of?central?cannula(e) by?sternotomy?or?thoracotomy, 6 years and older.CPT33958Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician;?reposition peripheral?(arterial and/or venous) cannula(e),?percutaneous, 6 years and older (includes fluoroscopic guidance, when performed).CPT33962Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician;?reposition central?(arterial and/or venous) cannula(e),?open, 6 years and older (includes fluoroscopic guidance, when performed).CPT33964Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician;?reposition central?cannula(e) by?sternotomy?or?thoracotomy, 6 years and older (includes fluoroscopic guidance, when performed).CPT33966Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician;?removal?of?peripheral?(arterial and/or venous) cannula(e),?percutaneous, 6 years and older.CPT33984Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician;?removal?of?peripheral?(arterial and/or venous) cannula(e),?open, 6 years and older.CPT33986Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician;?removal?of?central?cannula(e) by?sternotomy?or?thoracotomy, 6 years and older.ICD10PCS5A1522FExtracorporeal Oxygenation, Membrane, CentralICD10PCS5A1522GExtracorporeal Oxygenation, Membrane, Peripheral Veno-arterialICD10PCS5A1522HExtracorporeal Oxygenation, Membrane, Peripheral Veno-venousICD10PCS5A15223Extracorporeal Membrane Oxygenation, ContinuousECMO or invasive MV?DRG003ECMO or tracheostomy with MV > 96 hours or PDX except face, mouth and neck with major O.R. procedureDRG004Tracheostomy with MV > 96 hours or PDX except face, mouth and neck without major O.R. procedureDRG207Respiratory system diagnosis with ventilatory support > 96 hoursDRG208Respiratory system diagnosis with ventilatory support ≤ 96 hoursDRG870Septicemia or severe sepsis with MV > 96 hoursAbbreviations: CPT, Current Procedural Terminology; DRG, Diagnosis Related Group; ECMO, extracorporeal membrane oxygenation; ICD, International Classification of Diseases; MV, mechanical ventilation; PCS, Procedure Coding SystemTable S2 Sample AttritionCohort selection stepNumber of hospitalizationsMarketScan? Commercial Claims and Encounters and Medicare Supplemental and Coordination of Care databaseMedicare-FFSAll primary or secondary diagnosis of viral pneumonia between January 1, 2018 and June 30, 201922,338148,938Meeting diagnosis code and age criteriaa6,083120,812Total payment > 0 6,083118,843Excluding hospitalizations with ECMO or with iMV but no ICU6,055118,419Notes: aDiagnosis code criteria were ICD-10-CM J09 (Influenza due to certain identified influenza virus), J10 (Influenza due to other identified influenza virus), J11 (Influenza due to unidentified influenza virus), or J12 (Viral pneumonia, not elsewhere classified) in the primary/discharge diagnosis position, or J80 (Acute respiratory distress syndrome) if accompanied by J09, J10, J11, or J12 in the secondary position; age criteria were > 18 years for the MarketScan? database and ≥ 65 years for the Medicare FFS database.Abbreviations: ECMO, extracorporeal membrane oxygenation; FFS, fee for service; ICU, intensive care unit; iMV, invasive mechanical ventilationTable S3 Ordinary Least Squares Regression Analysis for Estimating Incremental Costs of an Additional Inpatient Day for Viral Pneumonia Among Commercially-insured Claims PatientsVariableHospitalizations with ICUICUBase case(n = 1,356)aSensitivity analysis on all qualified hospitalizations(n = 1,378)Base case(n = 1,366)aSensitivity analysis on all qualified hospitalizations(n = 1,378)Estimate (SE), $PEstimate (SE), $PEstimate (SE), $PEstimate (SE), $PIntercept16,322 (2,559)< 0.000118,286 (5,707)0.001411,208 (4,893)0.022113,326 (6007)0.0267Male1,102 (1,317)0.40317,051 (2,968)0.01763,415 (2,468)0.1676,780 (3,084)0.0281Age group, years45-64695 (1,872)0.7105-2245 (4,202)0.59332,318 (3,502)0.508-852 (4,368)0.845465-74-131 (2,838)0.9632-8814 (6,400)0.1687619 (5,312)0.907-4,319 (6,652)0.5163≥ 751248 (2,1004)0.5531-5800 (2,968)0.21953,752 (3,931)0.34-1,813 (4,904)0.7116Geographic regionNorth central1516 (2,161)0.48330 (4798)0.995-4,710 (4,148)0.2564-4,870 (5,077)0.3376Northeast18153 (2,422)< 0.000111668 (5402)0.03117,741 (4,559)0.000114,002 (5,627)0.013South7285 (1,935)0.00026426 (4302)0.13555,060 (3,769)0.1796220 (4.598)0.9618West16,322 (2,559)< 0.000118286 (5707)0.001411,208 (4,893)0.022113,326 (6,007)0.0267iMV25,293 (3,116)< 0.000114,360 (6,806)0.035135,482 (5,761)< 0.000119,759 (7,072)0.0053Additional day3,900 (157)< 0.00015,646 (258)< 0.00015,254 (394)< 0.00016,853 (371)< 0.0001Notes: aLength of stay or costs that exceeded the 99th percentile were excluded.Abbreviations: ICU, intensive care unit; iMV, invasive mechanical ventilation; LOS, length of stay; SE, standard errorTable S4 Ordinary Least Squares Regression Analysis for Estimating Incremental Costs of an Additional Inpatient Day for Viral Pneumonia Among Medicare-FFS Claims PatientsVariableHospitalizations with ICUICUBase case(n = 27,836)aSensitivity analysis on all hospitalizations(n = 28,249)Base case(n = 27,836)aSensitivity analysis on all hospitalizations(n = 28,249)Estimate (SE), $PEstimate (SE), $PEstimate (SE), $PEstimate (SE), $PIntercept18,559 (162)< 0.000118,315 (257)< 0.000121,928 (168)< 0.000122,964 (267)< 0.0001SexFemale-147 (59)0.0128-337 (96)0.0004-36 (64)0.5681-193 (103)0.0623Male0—0—0—0—Age group, years65-70910 (88)< 0.00011549 (144)< 0.0001762 (96)< 0.00011,462 (155)< 0.000171-75696 (88)< 0.00011247 (143)< 0.0001577 (95)< 0.00011,187 (154)< 0.000176-80498 (87)< 0.0001937 (142)< 0.0001430 (95)< 0.0001891 (153)< 0.000181-85274 (88)0.0019456 (144)0.0016247 (96)0.0102420 (156)0.007≥ 860—0—0—0—Geographic regionMidwest-2350 (88)< 0.0001-3143 (144)< 0.0001-2246 (96)< 0.0001-3,024 (155)< 0.0001Northeast-1241 (99)< 0.0001-1770 (160)< 0.0001-805 (107)< 0.0001-1,002 (172)< 0.0001South-2733 (82)< 0.0001-3471 (133)< 0.0001-2754 (89)< 0.0001-3,583 (144)< 0.0001West0—0—0—0—US territories-4314 (742)< 0.0001-7082 (1,166)< 0.0001-2733 (805)0.0007-5,602 (1256)< 0.0001Foreign countries4857 (2797)0.08241991 (4,594)0.66476596 (3035)0.02974,388 (4948)0.3752iMVNo-11,693 (119)< 0.0001-14,155 (188)< 0.0001-13,101 (127)< 0.0001-16,215 (200)< 0.0001Yes0—0—0.00—0.00—Additional day668 (7)< 0.00011150 (10)< 0.0001608 (11)< 0.00011,260 (14)< 0.0001Notes: aLength of stay or costs that exceeded the 99th percentile were excluded.Abbreviations: ICU, intensive care unit; iMV, invasive mechanical ventilation; LOS, length of stay; SE, standard error ................
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