Impact of postoperative venous thromboembolism on Medicare recipients undergoing total hip replacement or total knee replacement surgery

Başer, Onur; Supina, Dylan; Sengupta, Nishan; Wang, Li; Kwong, Louis M.

doi:10.2146/ajhp090572

Cited by 27 publications

(21 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More studies are needed of the costs of treating VTE in specific patient groups such as major orthopedic surgical patients [76] and pediatric patients [77]. One study reported that the total cost of care during the first 6 months post-discharge from orthopedic surgery was $3500 [78], whereas another study reported that the monthly cost during the first 3 months was $3300 higher than for matched controls [79].…”

Section: Discussionmentioning

confidence: 99%

The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs

Grosse

Nelson

Nyarko

et al. 2016

Thrombosis Research

373

242

View full text Add to dashboard Cite

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is an important cause of preventable mortality and morbidity. In this study, we summarize estimates of per-patient and aggregate medical costs or expenditures attributable to incident VTE in the United States. Per-patient estimates of incremental costs can be calculated as the difference in costs between patients with and without an event after controlling for differences in underlying health status. We identified estimates of the incremental per-patient costs of acute VTEs and VTE-related complications, including recurrent VTE, post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension, and anticoagulation-related adverse drug events. Based on the studies identified, treatment of an acute VTE on average appears to be associated with incremental direct medical costs of $12,000 to $15,000 (2014 US dollars) among first-year survivors, controlling for risk factors. Subsequent complications are conservatively estimated to increase cumulative costs to $18,000–23,000 per incident case. Annual incident VTE events conservatively cost the US healthcare system $7–10 billion each year for 375,000 to 425,000 newly diagnosed, medically treated incident VTE cases. Future studies should track long-term costs for cohorts of people with incident VTE, control for comorbid conditions that have been shown to be associated with VTE, and estimate incremental medical costs for people with VTE who do not survive. The costs associated with treating VTE can be used to assess the potential economic benefit and cost-savings from prevention efforts, although costs will vary among different patient groups.

show abstract

Section: Discussionmentioning

confidence: 99%

The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs

Grosse

Nelson

Nyarko

et al. 2016

Thrombosis Research

373

242

View full text Add to dashboard Cite

show abstract

“…For outpatient events, we developed a pilot NLP system to identify clinical notes with mentions of PE, DVT, or VTE [23–25]. Each mention was associated with the date the clinic note was created.…”

Section: Methodsmentioning

confidence: 99%

Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005–2010

Nelson

Grosse

Waitzman

et al. 2015

Thrombosis Research

View full text Add to dashboard Cite

Background There are limitations to using administrative data to identify postoperative venous thromboembolism (VTE). We used a novel approach to quantify postoperative VTE events among Department of Veterans Affairs (VA) surgical patients during 2005–2010. Methods We used VA administrative data to exclude patients with VTE during 12 months prior to surgery. We identified probable postoperative VTE events within 30 and 90 days post-surgery in three settings: 1) pre-discharge inpatient, using a VTE diagnosis code and a pharmacy record for anticoagulation; 2) post-discharge inpatient, using a VTE diagnosis code followed by a pharmacy record for anticoagulation within 7 days; and 3) outpatient, using a VTE diagnosis code and either anticoagulation or a therapeutic procedure code with natural language processing (NLP) to confirm acute VTE in clinical notes. Results Among 468,515 surgeries without prior VTE, probable VTEs were documented within 30 and 90 days in 3,931 (0.8%) and 5,904 (1.3%), respectively. Of probable VTEs within 30 or 90 days post-surgery, 47.8% and 62.9%, respectively, were diagnosed post-discharge. Among post-discharge VTE diagnoses, 86% resulted in a VA hospital readmission. Fewer than 25% of outpatient records with both VTE diagnoses and anticoagulation prescriptions were confirmed by NLP as acute VTE events. Conclusion More than half of postoperative VTE events were diagnosed post-discharge; analyses of surgical discharge records are inadequate to identify postoperative VTE. The NLP results demonstrate that the combination of VTE diagnoses and anticoagulation prescriptions in outpatient administrative records cannot be used to validly identify postoperative VTE events.

show abstract

“…Since most shoulder arthroplasties are elective, it is important to estimate how commonly serious postoperative complications such as cardiac and thromboembolic complications occur and what factors are associated with them. Cardiac and thromboembolic complications are associated with significantly higher morbidity and mortality in arthroplasty patients (3)(4, 5). A better understanding of these potentially fatal complications after shoulder arthroplasty will allow both surgeons and patients to make better informed decisions regarding this elective procedure.…”

mentioning

confidence: 99%

Cardiopulmonary Complications After Primary Shoulder Arthroplasty: A Cohort Study

Singh

Sperling

Cofield

2012

Seminars in Arthritis and Rheumatism

View full text Add to dashboard Cite

Objective Study the frequency and predictors of 90-day cardiopulmonary complications following primary shoulder arthroplasty Methods We used prospectively collected data from the Mayo Clinic Total Joint registry from 1976–2008. We used univariate and multivariable-adjusted Cox regression analyses to examine the association of age, gender, body mass index (BMI), comorbidity assessed by Deyo-Charlson index, American Society of Anesthesiologist (ASA) class, implant fixation (cemented versus not) and underlying diagnosis with the risk of 90-day cardiopulmonary complications after primary shoulder arthroplasty. Odds ratio (OR) with 95% confidence interval (CI) and p-values are presented. Results 3,480 patients underwent 4,019 primary shoulder arthroplasties. 90-day cardiac and thromboembolic complication rates following primary shoulder arthroplasty were 2.6% (92/3480) and 1.2% (42/3480). After multivariable-adjustment, age >70 years (OR, 2.7; 95% CI: 1.2–5.9; p-value= 0.01; relative to age <60), Deyo-Charlson comorbidity index of 1 or more (OR, 3.27; 95% CI:1.9–5.6; p<0.0001; relative to index of 0) and prior cardiac events (OR, 7.87; 95% CI: 4.89–12.68; p<0.0001; relative to no prior event) were associated with higher odds of 90-day cardiac complications. Due to few thromboembolic events, only univariate analyses were performed. Univariately, female gender, age >70 years, BMI 25–29.9 kg/m2, Deyo Charlson index of 1 or more, underlying diagnosis of trauma, prior thromboembolic event and surgery type were each associated with significantly higher risk of 90-day thromboembolic event (p≤0.03 for all). Conclusions Cardiac and thromboembolic complications are uncommon after primary shoulder arthroplasty. Patients can be informed of their risk of cardiac complications following shoulder arthroplasty based on presence of risk factors.

show abstract

Impact of postoperative venous thromboembolism on Medicare recipients undergoing total hip replacement or total knee replacement surgery

Abstract: Patients who developed VTE after THR or TKR had a higher likelihood of mortality, bleeding, and rehospitalization; were hospitalized longer; and incurred higher costs to Medicare, Medicare beneficiaries, and private payers compared with patients without VTE.

Cited by 27 publications

References 18 publications

The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs

The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs

Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005–2010

Cardiopulmonary Complications After Primary Shoulder Arthroplasty: A Cohort Study

Contact Info

Product

Resources

About