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

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.

Risk factors and distribution of symptomatic venous thromboembolism in total hip and knee replacements: prospective study

“…Although not statistically significant, VTE incidence rates tended to be greater following knee arthroplasty surgery (2.8% versus 2.6% following hip arthroplasty surgery), as seen in other countries [12,20], possibly relating to the use of a thigh tourniquet and the associated venous stasis, more extensive soft-tissue damage, the release of prothrombotic tissue factors and longer surgical times [21].…”

“…Despite the American College of Chest Physicians (ACCP) [3] recommendations for the prolonged use of thromboprophylactics, longer courses of treatment are still not routine practice in many hospitals in Serbia, or indeed in many other countries [20,21]. The explanations for this lie with an inadequate organisation of our primary healthcare services (for home visits and the administration of thromboprophylaxis for our discharged patients), the high cost of many of the thromboprophylactic agents, the fears of perioperative haemorrhage and heparin-induced thrombocytopenia (HIT), and a possible lack of sufficient awareness of our surgeons about the significantly high risks of thromboembolic complications (PE and DVT) in the post-hospitalisation period.…”

Thromboprophylaxis Following Hip And Knee Arthroplasty

“…As previously noted, VTE occurs more commonly after discharge. 51,62,143,184,185 It is likely then that the 90-day incidence would have been close to double the previous study (2.7%), however only a 90 day follow up with the cohort could confirm this.…”

“…62, 184 The majority of VTE occurred following discharge, which has also been previously reported in the literature. 51,62,143,184,185 As all readmissions to hospital for VTE treatment were under medical units, local VTE incidence following arthroplasty may be underestimated by surgical teams.…”

“…182 A perception that VTE risk is too low to warrant prophylaxis is not surprising given the median time to a symptomatic VTE following surgery is 17 to 30 days and the vast majority of VTE are asymptomatic and/or occur post-discharge. 184,185 Moreover, the length of hospital stay has shortened over the years. As previously mentioned, some patients stay in hospital as little as 2 days after surgery, and it is not uncommon for patients to be discharged before regaining full mobility, thereby increasing their risk of VTE.…”