Incidence of hospital‐acquired venous thromboembolic codes in medical patients hospitalized in academic medical centers. Issue 4 (5th February 2014) - Khanna, Raman
Abstract BACKGROUND 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. OBJECTIVE Establish the incidence and composition of HA‐VTE/superficial venous thrombosis (SVT) coded in a large cohort of medical patients. DESIGN Retrospective analysis of discharges. SETTING Eighty‐three academic medical centers in UHC (formerly University HealthSystem Consortium). PATIENTS Patients with medical diagnoses hospitalized >2 days between October 1, 2009, and March 31, 2011. MEASUREMENTS Incidence and anatomic location of HA‐VTE codes, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for VTE coupled to a present‐on‐admission indicator flag set to "No." RESULTS 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. CONCLUSION 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. Journal of Hospital Medicine 2014;9:221–225. © 2014 Society of Hospital Medicine