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World Journal of Surgery

Published in:

01-02-2012

Incidence and Prevention of Postoperative Venous Thromboembolism: Are They Meaningful Quality Indicators in Japanese Health Care Settings?

Authors: Susumu Kunisawa, Hiroshi Ikai, Yuichi Imanaka

Published in: World Journal of Surgery | Issue 2/2012

Abstract

Background

Venous thromboembolism (VTE) epidemiology varies widely across surgical procedures. At present, there are few epidemiologic reports regarding VTE in Japan. Japanese VTE prophylaxis guidelines recommend a risk-based approach based on previous epidemiologic statistics. VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE). PE prevention is the main goal, although the relation between PE and DVT is still controversial.

Methods

We collected administrative data for 1,016,496 surgical patients from 260 hospitals. We analyzed DVT and PE incidence and selected two subgroups for further analysis: gastroenterologic surgery and specific orthopedic surgery (high-frequency group).

Results

Overall DVT incidence was 1947 (0.19%); and the PE incidence was 538 (0.05%). DVT case fatality rate was 3.44% (67/1947); that for PE was 22.86% (123/538). Both overall and subgroup incidences were comparable to those in previous reports. Subgroup analyses in the high-frequency group did not show a relation between DVT and PE. VTE prophylaxis did not show a relation between DVT and PE despite 99% adherence.

Conclusions

Our results are consistent with established data regarding DVT and PE incidence. Administrative data available in Japan provides a powerful epidemiologic tool to characterize rare diseases such as DVT and PE. DVT is not a suitable quality indicator in Japan. However, PE is too rare to be considered a rate-based outcome indicator, and VTE prophylaxis is too widely applied to be used as a process indicator. VTE measurement is not a useful quality indicator in Japan to compare hospitals but provides a longitudinal self-survey.

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Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 133:381S–453SPubMedCrossRef

American Academy of Orthopaedic Surgeons Board of Directors (2007) American Academy of Orthopaedic Surgeons Clinical Guideline on Prevention of Pulmonary Embolism in Patients Undergoing Total Hip or Knee Arthroplasty. Available at: http://www.aaos.org/research/guidelines/pe_guideline.pdf. Accessed 11 Mar 2011

U.S. Department of Health and Human Services (2008) The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Available at: http://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdf. Accessed 11 Mar 2011

Editorial Committee on Japanese Guideline for Prevention of Venous Thromboembolism (2004) Japanese Guideline for Prevention of Venous Thromboembolism. Medical Front International, Tokyo (in Japanese)

The Japanese Circulation Society (2009) Guidelines for the Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism and Deep Vein Thrombosis. Available at: http://www.j-circ.or.jp/guideline/pdf/JCS2009_andoh_h.pdf. Accessed 20 Feb 2011 (in Japanese)

The Agency for Healthcare Research and Quality (2011) Available at: http://www.qualityindicators.ahrq.gov/. Accessed 1 June 2011

Eikelboom JW, Karthikeyan G, Fagel N et al (2009) American Association of Orthopedic Surgeons and American College of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients? Chest 135:513–520PubMedCrossRef

Kuroiwa M, Furuya H, Seo N et al (2010) Incidence and clinical characteristics of perioperative pulmonary thromboembolism in Japan in 2008: results from the annual study of Japanese Society of Anesthesiologists, Committee on Patient Safety and Risk Management, Perioperative Pulmonary Thromboembolism Working Group]. Masui 59:667–673 (in Japanese)PubMed

Kumasaka N, Sakuma M, Shirato K (1999) Incidence of pulmonary thromboembolism in Japan. Jpn Circ J 63:439–441PubMedCrossRef

10.

Montagnana M, Favaloro EJ, Franchini M et al (2010) The role of ethnicity, age and gender in venous thromboembolism. J Thromb Thrombolysis 29:489–496PubMedCrossRef

11.

The Joint Commission (2010) Venous Thromboembolism (VTE) Core Measure Set. Available at: http://www.jointcommission.org/. Accessed 1 Mar 2011

12.

Mainz J (2003) Defining and classifying clinical indicators for quality improvement. Int J Qual Health Care 15:523–530PubMedCrossRef

Title: Incidence and Prevention of Postoperative Venous Thromboembolism: Are They Meaningful Quality Indicators in Japanese Health Care Settings?
Authors: Susumu Kunisawa
Hiroshi Ikai
Yuichi Imanaka
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 2/2012
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-011-1229-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Incidence and Prevention of Postoperative Venous Thromboembolism: Are They Meaningful Quality Indicators in Japanese Health Care Settings?

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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