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Published in:

01-11-2009

Rates of symptomatic venous thromboembolism in US surgical patients: a retrospective administrative database study

Authors: Alex C. Spyropoulos, Mohammed Hussein, Jay Lin, David Battleman

Published in: Journal of Thrombosis and Thrombolysis | Issue 4/2009

Abstract

US national performance measures may reduce the burden of venous thromboembolism (VTE) in surgical patients. To characterize the VTE rate in US surgical patients, and identify real-world independent VTE risk-factors, a national managed-care database was analyzed. 172,320 eligible surgical discharges (23.9% orthopedic, 76.1% abdominal surgery) from the PharMetrics database (January 2001–December 2005) were evaluated. The rate of thromboprophylaxis was low in orthopedic (40.5%) and abdominal (1.8%) surgery discharges, with the event rates of symptomatic VTE in these groups being 4.7% and 3.1%, respectively. The median time to VTE was 51 days: the majority of VTE events occurred post-discharge. Independent predictors of VTE included prior VTE (odds ratio [OR] 10.2; 95% CI: 9.2–11.4), and orthopedic versus abdominal surgery (OR 1.4; 95% CI: 1.4–1.6). Patients undergoing orthopedic or abdominal surgery remain at-risk for VTE. Implementation of national performance measures may help reduce the burden of VTE.

Medicare Quality Improvement Committee SCIP Project Information. Available at: www.medqic.org/scip/. Accessed 17 July 2008

The Joint Commission JCAHO: Available at: www.jointcommission.org. Accessed 17 July 2008

U.S. Department of Health and Human Services. The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism 2008. Available at: http://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdf. Accessed 6 October 2008

Anderson FA Jr, Zayaruzny M, Heit JA, Fidan D, Cohen AT (2007) Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism. Am J Hematol 82:777–782. doi:10.1002/ajh.20983 CrossRefPubMed

Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines, 8th edn. Chest 133(6 Suppl):381S–453S

Rogers F, Rebuck JA, Sing RF (2007) Venous thromboembolism in trauma: an update for the intensive care unit practitioner. J Intensive Care Med 22:26–37. doi:10.1177/0885066606295291 CrossRefPubMed

White RH, Gettner S, Newman JM, Trauner KB, Romano PS (2000) Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med 343:1758–1764. doi:10.1056/NEJM200012143432403 CrossRefPubMed

Gangireddy C, Rectenwald JR, Upchurch GR et al (2007) Risk factors and clinical impact of postoperative symptomatic venous thromboembolism. J Vasc Surg 45:335–341. doi:10.1016/j.jvs.2006.10.034 CrossRefPubMed

Spencer FA, Lessard D, Emery C, Reed G, Goldberg RJ (2007) Venous thromboembolism in the outpatient setting. Arch Intern Med 167:1471–1475. doi:10.1001/archinte.167.14.1471 CrossRefPubMed

10.

Friedman RJ (2007) Optimal duration of prophylaxis for venous thromboembolism following total hip arthroplasty and total knee arthroplasty. J Am Acad Orthop Surg 15:148–155PubMed

11.

Amin AN, Stemkowski S, Lin J, Yang G (2008) Preventing venous thromboembolism in US hospitals: are surgical patients receiving appropriate prophylaxis? Thromb Haemost 99:796–797PubMed

12.

United States Department of Health & Human Services. Medical privacy—national standards to protect the privacy of personal health information. Available at: www.hhs.gov/ocr/hipaa. Accessed 12 September 2008

13.

United States Department of Health & Human Services. Policy for protection of human research subjects. Available at: http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm#46.101. Accessed 17 July 2008

14.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383. doi:10.1016/0021-9681(87)90171-8 CrossRefPubMed

15.

Heit JA, Silverstein MD, Mohr DN et al (2000) Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 160:809–815. doi:10.1001/archinte.160.6.809 CrossRefPubMed

16.

Bergqvist D, Agnelli G, Cohen AT et al (2002) Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346:975–980. doi:10.1056/NEJMoa012385 CrossRefPubMed

17.

Rasmussen MS, Jorgensen LN, Wille-Jorgensen P. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev 2009 Jan 21(1):CD004318

18.

Friedman RJ, Dunsworth GA (2000) Cost analyses of extended prophylaxis with enoxaparin after hip arthroplasty. Clin Orthop Relat Res 370:171–182. doi:10.1097/00003086-200001000-00016 CrossRefPubMed

19.

Bergqvist D, Jönsson B (1999) Cost-effectiveness of prolonged administration of a low molecular weight heparin for the prevention of deep venous thrombosis following total hip replacement. Value Health 2:288–294. doi:10.1046/j.1524-4733.1999.24003.x CrossRefPubMed

20.

Dahl OE, Pleil AM (2003) Investment in prolonged thromboprophylaxis with dalteparin improves clinical outcomes after hip replacement. J Thromb Haemost 1:896–906. doi:10.1046/j.1538-7836.2003.00236.x CrossRefPubMed

21.

Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, Huang W, Zayaruzny M, Emery L, Anderson FA Jr, ENDORSE Investigators (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371:387–394. doi:10.1016/S0140-6736(08)60202-0 CrossRefPubMed

22.

Arcelus JI, Monreal M, Caprini JA et al (2008) Clinical presentation and time-course of postoperative venous thromboembolism: Results from the RIETE registry. Thromb Haemost 99:546–551PubMed

23.

Seddighzadeh A, Zurawska U, Shetty R, Goldhaber SZ (2007) Venous thromboembolism in patients undergoing surgery: low rates of prophylaxis and high rates of filter insertion. Thromb Haemost 98:1220–1225PubMed

24.

Centers for Medicare and Medicaid Services CMS Fact Sheet. CMS proposes additions to the list of hospital-acquired condition for fiscal year 2009. 2008. At: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3042&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=false&cboOrder=date. Accessed 6 March 2009

25.

Spyropoulos AC, Hurley JS, Ciesla GN, de Lissevoy G (2002) Management of acute proximal deep vein thrombosis: pharmacoeconomic evaluation of outpatient treatment with enoxaparin vs inpatient treatment with unfractionated heparin. Chest 122:108–114. doi:10.1378/chest.122.1.108 CrossRefPubMed

26.

Spyropoulos AC, Lin J (2007) Direct medical costs of venous thromboembolism and subsequent hospital readmission rates: an administrative claims analysis from 30 managed care organizations. J Manag Care Pharm 13:475–486PubMed

27.

Heit JA (2006) The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thromb Thrombolysis 21:23–29. doi:10.1007/s11239-006-5572-y CrossRefPubMed

Title: Rates of symptomatic venous thromboembolism in US surgical patients: a retrospective administrative database study
Authors: Alex C. Spyropoulos
Mohammed Hussein
Jay Lin
David Battleman
Publication date: 01-11-2009
Publisher: Springer US
Published in: Journal of Thrombosis and Thrombolysis / Issue 4/2009
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI: https://doi.org/10.1007/s11239-009-0351-1

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