Incidence of hospital‐acquired venous thromboembolic codes in medical patients hospitalized in academic medical centers. Issue 4 (5th February 2014)

• Record Type: Journal Article
• Authors: Khanna, Raman; Maynard, Gregory; Sadeghi, Banafsheh; Hensley, Laurie; Medvedev, Sofia; Danielsen, Beate; White, Richard H.
• Is Part Of: Journal of hospital medicine. Volume 9:Issue 4(2014)
• Page Start: 221
• Page End: 225
• Publication Date: 2014-02-05
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2159
• Languages: English
• ISSNs: 1553-5592

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jhm2159-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>Hospital‐acquired venous thromboembolism (HA‐VTE, VTE occurring during a hospitalization) codes in hospital billing data are often used as a surrogate for hospital‐associated VTE events occurring during or up to 30 days after a hospitalization, which are more difficult to measure.</p> </sec> <sec id="jhm2159-sec-0002" sec-type="section"> <title>OBJECTIVE</title> <p>Establish the incidence and composition of HA‐VTE/superficial venous thrombosis (SVT) coded in a large cohort of medical patients.</p> </sec> <sec id="jhm2159-sec-0003" sec-type="section"> <title>DESIGN</title> <p>Retrospective analysis of discharges.</p> </sec> <sec id="jhm2159-sec-0004" sec-type="section"> <title>SETTING</title> <p>Eighty‐three academic medical centers in UHC (formerly University HealthSystem Consortium).</p> </sec> <sec id="jhm2159-sec-0005" sec-type="section"> <title>PATIENTS</title> <p>Patients with medical diagnoses hospitalized >2 days between October 1, 2009, and March 31, 2011.</p> </sec> <sec id="jhm2159-sec-0006" sec-type="section"> <title>MEASUREMENTS</title> <p>Incidence and anatomic location of HA‐VTE codes, defined as <italic>International Classification of Diseases, Ninth Revision, Clinical Modification</italic> codes for VTE coupled to a present‐on‐admission indicator flag set to "No."</p> </sec> <sec id="jhm2159-sec-0007" sec-type="section"> <title>RESULTS</title> <p>Among 2, 525, 068 medical hospitalizations, 12, 847 (0.51%) cases had ≥1 thrombotic code; 2449 (19.1%) with pulmonary embolism (PE), and 3848 (30%) with lower‐extremity deep venous thrombosis (LE‐DVT) without PE. Upper‐extremity DVT (2893; 22.5%) and SVT (3248; 25.3%) comprised the bulk of remaining cases. Among cases with HA‐PE/LE‐DVT, 34.3% had cancer, 47.8% received care in an intensive care unit, 78% had severe or extreme severity of illness, and 16.5% died in the hospital. Overall, 54.9% of the patients who developed a HA‐PE/LE‐DVT had been started on VTE pharmacoprophylaxis on hospital day 1 or 2.</p> </sec> <sec id="jhm2159-sec-0008" sec-type="section"> <title>CONCLUSION</title> <p>At academic centers, HA‐VTE/SVT is coded in 0.51% of medical inpatients, and HA‐PE/LE‐DVT is coded in half of those. Most patients with HA‐PE/LE‐DVT are severely ill and develop VTE despite receiving prophylaxis. <italic>Journal of Hospital Medicine</italic> 2014;9:221–225. © 2014 Society of Hospital Medicine</p> </sec> </abstract>