scholarly journals Concordance of Identified Cases of Pediatric HA-VTE with American College of Physicians and Cincinnati Children’s Hospital HA-VTE Prophylaxis Guidelines Over a 10-Year Period

2020 ◽  
Vol 7 ◽  
pp. 2333794X2096027
Author(s):  
Elaine M. Fan ◽  
Deirdre Lewis ◽  
Thomas Presti ◽  
Nura El-Haj ◽  
Weijen W. Chang
Keyword(s):  
Venous Thromboembolism ◽  
Pediatric Patients ◽  
Hospital Admissions ◽  
The United States ◽  
Tertiary Hospital ◽  
Central Line ◽  
Vte Prophylaxis ◽  
Routine Prophylaxis ◽  
Icd 10 ◽  
Hospital Acquired

Objective: Our aim is to (1) ascertain the proportion of pediatric patients at a tertiary hospital in Western Massachusetts over a 10-year period with hospital-acquired venous thromboembolism (VTE) of particular characteristics and (2) determine whether ACCP or Cincinnati Children’s guidelines would have recommended VTE prophylaxis in these patients. Setting: Urban teaching hospital in the United States. Participants: Data from 98 477 pediatric hospital admissions (roughly 10 000 admission per year) from 2008 to 2017 were reviewed. There were a total of 177 VTE cases identified. Outcome measures: Hospital-acquired venous thromboembolism (including deep venous thrombosis and pulmonary embolism). Result: 177 charts were extracted that carried the diagnosis of VTE based on ICD-9 and ICD-10 codes over a 10-year-period. Among these patients, 34 (19%) met the inclusion criteria for HA-VTE; 5 (16%) would qualify for prophylaxis according to ACCP and 7 (21%) according to Cincinnati Children’s guideline. The most common age group to have a VTE was infants under 1 year of age (41%), and the most common characteristic was the presence of a central line (82%). Age outside of the recommended range was the sole reason that excluded patients from prophylaxis qualification per Cincinnati Children’s. Conclusion: HA-VTE carries increased morbidity and mortality. Although recognition and prevention of HA-VTE in adult populations are routine, prophylaxis for pediatric HA-VTE is not commonly practiced. This may be due to paucity of strong evidence supporting prophylaxis and the challenge of identifying risk factors for HA-VTE. Our results suggest that published guidelines recommend prophylaxis in only a minority of pediatric patients who would have subsequently developed HA-VTE. Further modification and validation of current guidelines are needed to effectively prevent pediatric HA-VTE.

scholarly journals A Retrospective Review of Hospital-Acquired Venous Thromboembolism at a Large Pediatric Tertiary Care Center

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3471-3471
Author(s):  
Marissa A. Just ◽  
Joanna Robles ◽  
Karan R. Kumar ◽  
Andrew Yazman ◽  
Jennifer A. Rothman ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Research Funding ◽  
Pediatric Patients ◽  
Central Venous ◽  
Vte Prophylaxis ◽  
Children's Hospital ◽  
Congenital Cardiac Disease ◽  
Children’S Hospital ◽  
Icd 10 ◽  
Hospital Acquired

Introduction: The incidence of venous thromboembolism (VTE) in hospitalized pediatric patients is increasing secondary to the growing medical complexity of pediatric patients and the increasing use of central venous catheters. Pediatric patients diagnosed with VTE have up to 2% mortality associated directly with their thromboses. While incidence, risk factor identification and preventive strategies are well established in hospitalized adults, this information is limited in the pediatric population. There are currently no standardized VTE risk screening tools or thromboprophylaxis guidelines for children at Duke Children's Hospital. The incidence of hospital acquired VTE (HA-VTE), as well as their associated risk factors were investigated in a retrospective review. Methods: Medical records of pediatric patients hospitalized at Duke Children's Hospital during June 2018 through November 2018 were reviewed. The EPIC SlicerDicer tool was used to identify patients with ICD-10 diagnoses codes related to thrombosis or treated with anticoagulants. Included patients were diagnosed with HA-VTE during their hospitalization or within 14 days of discharge. Data collected included demographics, thrombosis characteristics, family history, mobility, and acute or chronic co-morbid conditions. The characteristics of the study population were described by median (with 25th and 75th percentiles) for continuous variables and frequencies (with percentages) for binary or categorical variables. Results: Out of 4,176 total pediatric admissions to all units of Duke Children's Hospital (ages 0-18.99 years) during the inclusion timeframe, 33 VTE events were identified. The incidence of VTE events per 1000 patient days was 0.98. The complete patient and VTE event characteristics are listed in Tables 1 and 2. The median age of patients with VTE events was 0.4 years. Of the identified cohort, 73% had an associated central venous line (CVL). Neonates with congenital cardiac disease comprised the majority of the cohort. Other common patient characteristics observed in this cohort included impaired mobility, recent major surgery, and recent mechanical ventilation. Of the 33 VTE diagnoses, 70% received therapeutic anticoagulation with enoxaparin or unfractionated heparin. Only 2 patients (8%) received prophylactic anticoagulation prior to their diagnosis of VTE. Conclusions: The retrospective review of HA-VTE events at Duke Children's Hospital identified that the majority of the events occurred in neonates with congenital cardiac disease and the presence of CVLs. It was also noted that there was no standardization among the use of anticoagulation agents that were initiated for treatment of VTE. Furthermore, few patients received VTE prophylaxis during the hospitalization. A limitation of this review was that it was retrospective and the documentation of family history of thrombosis was inconsistent. It is also possible that several VTE events were missed due to inadequate ICD-10 coding. Based on the results of this review, there is a need to implement a risk stratification tool and develop standardized recommendations of VTE prophylaxis and treatments for pediatric patients admitted to Duke Children's Hospital. There is an additional quality improvement phase of this project and the goal is to implement a risk calculator that is based on information learned from the retrospective review. Ultimately, this risk calculator will help to decrease the incidence of VTE events at Duke Children's Hospital. Disclosures Rothman: Agios: Honoraria, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Novartis: Honoraria, Research Funding.

scholarly journals Impact of Medicare’s Hospital-Acquired Condition Policy on Infections in Safety Net and Non–Safety Net Hospitals

2015 ◽  
Vol 36 (6) ◽  
pp. 649-655 ◽  
Author(s):  
Louise Elaine Vaz ◽  
Kenneth P. Kleinman ◽  
Alison Tse Kawai ◽  
Robert Jin ◽  
William J. Kassler ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Financial Incentives ◽  
Safety Net ◽  
The United States ◽  
Central Line ◽  
Unintended Consequences ◽  
Infection Rates ◽  
Healthcare Associated Infection ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

BACKGROUNDPolicymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals.OBJECTIVETo determine whether the 2008 Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy had a differential impact on targeted healthcare-associated infection rates in safety net compared with non–safety net hospitals.DESIGNInterrupted time-series design.SETTING AND PARTICIPANTSNonfederal acute care hospitals that reported central line–associated bloodstream infection and ventilator-associated pneumonia rates to the Centers for Disease Control and Prevention’s National Health Safety Network from July 1, 2007, through December 31, 2013.RESULTSWe did not observe changes in the slope of targeted infection rates in the postpolicy period compared with the prepolicy period for either safety net (postpolicy vs prepolicy ratio, 0.96 [95% CI, 0.84–1.09]) or non–safety net (0.99 [0.90–1.10]) hospitals. Controlling for prepolicy secular trends, we did not detect differences in an immediate change at the time of the policy between safety net and non–safety net hospitals (P for 2-way interaction, .87).CONCLUSIONSThe Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy did not have an impact, either positive or negative, on already declining rates of central line–associated bloodstream infection in safety net or non–safety net hospitals. Continued evaluations of the broad impact of payment policies on safety net hospitals will remain important as the use of financial incentives and penalties continues to expand in the United States.Infect Control Hosp Epidemiol 2015;00(0): 1–7

Impact of Postoperative Venous Thromboembolism on Postoperative Morbidity, Mortality, and Resource Utilization after Hepatectomy

2015 ◽  
Vol 81 (12) ◽  
pp. 1216-1223 ◽  
Author(s):  
Timothy E. Newhook ◽  
Damien J. Lapar ◽  
Dustin M. Walters ◽  
Shruti Gupta ◽  
Joshua S. Jolissaint ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Fold Increase ◽  
The United States ◽  
Albumin Level ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Resource Usage ◽  
Vte Prophylaxis ◽  
The Impact

The impact of venous thromboembolism (VTE) after hepatectomy on patient morbidity, mortality, and resource usage remains poorly defined. Better understanding of thromboembolic complications is needed to improve perioperative management and overall outcomes. About 3973 patients underwent hepatectomy within NSQIP between 2005 and 2008. Patient characteristics, operative features, and postoperative correlates of VTE were compared with identify risk factors for VTE and to assess its overall impact on postoperative outcomes. Overall incidence of postoperative VTE was 2.4 per cent. Risk factors for postoperative VTE included older age, male gender, compromised functional status, degree of intraoperative blood transfusion, preoperative albumin level (all P < 0.05), and extent of hepatectomy ( P = 0.004). Importantly, major postoperative complications, including acute renal failure, pneumonia, sepsis, septic shock, reintubation, prolonged ventilation, cardiac arrest, and reoperation were all associated with higher rates of VTE (all P < 0.05). Operative mortality was increased among patients with VTE (6.5% vs 2.4%, P = 0.03), and patients with VTE had a 2-fold increase in hospital length of stay (12.0 vs 6.0 days, P < 0.001). Postoperative VTE remains a significant source of morbidity, mortality, and increased resource usage after hepatectomy in the United States. Routine aggressive VTE prophylaxis measures are imperative to avoid development of VTE among patients requiring hepatectomy.

scholarly journals Venous Thromboembolism Prophylaxis and Risk for Acutely Medically Ill Patients Stratified by Different Ages and Renal Disease Status

2019 ◽  
Vol 25 ◽  
pp. 107602961882328 ◽  
Author(s):  
Alpesh Amin ◽  
W. Richey Neuman ◽  
Melissa Lingohr-Smith ◽  
Brandy Menges ◽  
Jay Lin
Keyword(s):  
Venous Thromboembolism ◽  
Renal Disease ◽  
Age Groups ◽  
Disease Status ◽  
The United States ◽  
Hospitalized Patients ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
Medically Ill Patients

The objectives of this study were to examine venous thromboembolism (VTE) prophylaxis patterns and risk for VTE events during hospitalization and in the outpatient continuum of care among patients hospitalized for acute illnesses in the United States with stratification by different age groups and renal disease status. Acutely ill hospitalized patients were identified from the MarketScan databases (January 1, 2012-June 30, 2015) and grouped by age (<65, 65-74, ≥75 years old) and whether or not they had a baseline diagnosis of renal disease, separately. Of acutely ill hospitalized patients, 60.1% (n = 10 748) were <65 years old, 15.7% (n = 2803) were 65 to 74 years old, and 24.3% (n = 4344) were ≥75 years old; 32.9% (n = 5892) had baseline renal disease. Among the study cohorts, the majority of patients received no VTE prophylaxis regardless of age or baseline renal status (52.1%-63.6%). Rates of VTE during hospitalization and in the 6 months postdischarge were 4.7%, 4.6%, and 4.5% for patients <65, 65 to 74, and ≥75 years old, respectively, and 6.3% and 3.8% for patients with and without baseline renal disease. The risk for VTE was elevated for 30 to 40 days after index admission regardless of age and renal disease status.

Head and Neck Microsurgeon Practice Patterns and Perceptions Regarding Venous Thromboembolism Prophylaxis

2020 ◽  
Vol 36 (08) ◽  
pp. 549-555
Author(s):  
Kaushik P. Venkatesh ◽  
Shoshana W. Ambani ◽  
Aris R.L. Arakelians ◽  
Jonas T. Johnson ◽  
Mario G. Solari
Keyword(s):  
United States ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Head And Neck ◽  
Free Flap ◽  
Practice Patterns ◽  
The United States ◽  
Bleeding Events ◽  
Vte Prophylaxis ◽  
Prophylactic Anticoagulation

Abstract Background Patients undergoing head and neck (H&N) microvascular reconstruction comprise a population at high risk for venous thromboembolism (VTE). Free flap and VTE thromboprophylaxis may coincide but tend to vary from surgeon to surgeon. This study identifies VTE prophylaxis patterns and perceptions among H&N microsurgeons in the United States. Methods An online survey on VTE prophylaxis practice patterns and perceptions was emailed to 172 H&N microsurgeons in the United States using an anonymous link. Results There were 74 respondents (43% response rate). These surgeons completed residencies in otolaryngology (59%), plastic surgery (31%), and oral maxillofacial surgery (7%). Most underwent fellowship training (95%) and have practiced at an academic center (97%) for at least 6 years (58%), performing an average of 42 ± 31 H&N free flap cases per year (range = 1–190). Most adhered to general VTE prophylaxis guidelines (69%) while 11% did not and 20% were unsure. Nearly all surgeons (99%) would provide prophylactic anticoagulation, mostly in the form of subcutaneous heparin (51%) or enoxaparin (44%); 64% additionally used aspirin, while 4% used aspirin alone. The majority of surgeons (68%) reported having postoperative VTE complications, with six surgeons (8%) reporting patient deaths due to pulmonary embolism. A third of the surgeons have encountered VTE prophylaxis-related adverse bleeding events, but most still believe that chemoprophylaxis is important for VTE prevention (92%). While 35% of surgeons were satisfied with their current practice, most would find it helpful to have official prophylactic anticoagulation guidelines specific to H&N free flap cases. Conclusion The majority of microsurgeons experienced postoperative VTE complications after H&N free flap reconstruction despite the routine use of prophylactic anticoagulation. Though bleeding events are a concern, most surgeons believe chemoprophylaxis is important for VTE prevention and would welcome official guidelines specific to this high-risk population.

The National Practice Patterns of Venous Thromboembolism Prophylaxis Post-Cardiothoracic Surgery

2016 ◽  
Vol 30 (4) ◽  
pp. 394-399 ◽  
Author(s):  
Sheena E. Mathew ◽  
Craig J. Beavers ◽  
Elizabeth McNeely
Keyword(s):  
Venous Thromboembolism ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The United States ◽  
Cardiothoracic Surgery ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Multicenter Survey ◽  
Pharmacologic Prophylaxis ◽  
Chemical Prophylaxis

Background: The rates of venous thromboembolism (VTE) post-cardiothoracic surgery are not well understood. The american college of chest physicians (CHEST) guidelines report weak recommendations for starting VTE prophylaxis post-cardiothoracic surgery. It is suspected that due to the increase in bleed risk, postsurgery initiation of pharmacologic VTE prophylaxis is limited. Objective: The study sought to investigate the use of VTE prevention in US hospitals performing cardiac surgery and the use of mechanical/chemical prophylaxis postoperatively. Methods: This is a multicenter survey distributed to cardiac hospitals in the United States. The survey was distributed through 3 separate listservs. Data were analyzed utilizing descriptive statistics. Results: The majority of the hospitals were academic and/or community and completed coronary artery bypass graft (CABG), valve replacement (mitral/aortic/tricuspid), and aortic repair. It was common for hospitals to start mechanical and pharmacologic prophylaxis post-cardiothoracic surgery on postoperative day (POD) 1 to 2. The anticoagulation most commonly used consisted of unfractionated heparin. Conclusions: The majority of the institutions are initiating therapy POD 1 to 2 with both mechanical and chemical prophylaxis. The full impact of early initiation of VTE prophylaxis is unknown, and more studies are needed to assess the true risks/benefits of these practices.

scholarly journals Improved Compliance With Venous Thromboembolism Pharmacologic Prophylaxis for Patients With Gynecologic Malignancies Hospitalized for Nonsurgical Indications Did Not Reduce Venous Thromboembolism Incidence

2015 ◽  
Vol 25 (1) ◽  
pp. 152-159 ◽  
Author(s):  
Lauren S. Prescott ◽  
Lisa M. Kidin ◽  
Rebecca L. Downs ◽  
David J. Cleveland ◽  
Ginger L. Wilson ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk Population ◽  
Gynecologic Malignancies ◽  
National Guidelines ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Discharge Outcomes ◽  
Pharmacologic Prophylaxis ◽  
Prophylactic Anticoagulation ◽  
Hospital Acquired

ObjectiveNational guidelines recommend prophylactic anticoagulation for all hospitalized patients with cancer to prevent hospital-acquired venous thromboembolism (VTE). However, adherence to these evidence-based recommended practice patterns remains low. We performed a quality improvement (QI) project to increase VTE pharmacologic prophylaxis rates among patients with gynecologic malignancies hospitalized for nonsurgical indications and evaluated the resulting effect on rates of development of VTE.Materials and MethodsIn June 2011, departmental VTE practice guidelines were implemented for patients with gynecologic malignancies who were hospitalized for nonsurgical indications. A standardized VTE prophylaxis module was added to the admission electronic order sets. Outcome measures included number of admissions receiving VTE pharmacologic prophylaxis within 24 hours of admission; and number of potentially preventable hospital-acquired VTEs diagnosed within 30 and 90 days of discharge. Outcomes were compared between a preguideline implementation cohort (n = 99), a postguideline implementation cohort (n = 127), and a sustainability cohort assessed 2 years after implementation (n = 109). Patients were excluded if upon admission they had a VTE, were considered low risk for VTE, or had a documented contraindication to pharmacologic prophylaxis.ResultsAdministration of pharmacologic prophylaxis within 24 hours of admission increased from 20.8% to 88.2% immediately following the implementation of guidelines, but declined to 71.8% in our sustainability cohort (P < 0.001). There was no difference in VTE incidence among the 3 cohorts [n = 2 (4.2%) vs n = 3 (3.9%) vs n = 3 (4.2%), respectively; P = 1.00].ConclusionsOur QI project improved pharmacologic VTE prophylaxis rates. A small decrease in prophylaxis during the subsequent 2 years suggests a need for continued surveillance to optimize QI initiatives. Despite increased adherence to guidelines, VTE rates did not decline in this high-risk population.

scholarly journals Postoperative Venous Thromboembolism in Children Is Increased in Setting of Cancer or Infection

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2391-2391
Author(s):  
Harold J. Leraas ◽  
Jina Kim ◽  
Zhifei Sun ◽  
Uttara P. Nag ◽  
Brian D. Ezekian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Venous Thromboembolism ◽  
Pediatric Patients ◽  
Conflicts Of Interest ◽  
Significant Risk ◽  
The United States ◽  
Improvement Program ◽  
Thrombotic Risk ◽  
Factors Associated

Abstract Background: Venous thromboembolism (VTE) is an uncommon but clinically significant postoperative complication in children. Incidence of VTE in pediatric patients ranges from 34-58 per 10,000 hospitalized children1. Due to rarity of these events, there is limited information about the factors predisposing children to VTE after surgery. We queried a national surgical database to identify risks and outcomes associated with VTE in pediatric surgical patients. Methods: The National Surgical Quality Improvement Program-Pediatric (NSQIP) is a prospectively collected database that records pediatric surgical information, surgical approaches, and 30 day patient outcomes. The database was queried for the years 2012-2013 to identify pediatric patients (age < 18) who had received surgical intervention and were diagnosed with postoperative VTE. Because of their separate coding in NSQIP, we defined VTE as including venous thromboembolism, or pulmonary embolism (PE) diagnosed radiographically within 30 days of operation. To reduce non-random differences between patients we used propensity scores based on age, sex, race, BMI, and ASA classification to match patients in a 1:2 ratio using the nearest neighbor method. Using univariate and multivariate analysis, we identified preoperative risk factors associated with VTE. Results: In total, 130 patients were identified who developed VTE postoperatively (VTE n=122, PE n=7, BOTH PE + VTE n= 1) from this database of 114,395 patients. There were 104 patients with VTE that also had complete entries and were subsequently analyzed in this study. Surgical specialties treating patients in this analysis included cardiothoracic surgery, general surgery, neurosurgery, orthopedic surgery, otolaryngology, plastic surgery, and urology. Eighty-one unique operative CPT codes were identified for patients with VTE. Patients who developed VTE had increased operative time, anesthesia time, and total length of stay (all p < 0.001). Multivariate analysis demonstrated that pneumonia (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.3 - 2.29), Central Line Associated Bloodstream Infection (CLABSI) (OR 1.69, 95% CI 1.18 - 2.42), sepsis (OR 1.47, 95% CI 1.18 - 1.82), septic shock (OR 1.36, 95% CI 1.06 - 1.75), and current solid or hematologic malignancy or active treatment of malignancy (OR 1.30, 95% CI 1.08 - 1.58) were all statistically significant risk factors associated with development of VTE (all p < 0.05). Conclusions: Postoperative VTE risk is significantly increased in children with malignancy or severe infections. Further research is needed to understand the mechanism between malignancy, systemic inflammation, and VTE risk in children. These findings may help to identify patients in need of prophylactic treatment in order to reduce postoperative thrombotic risk in pediatric patients. References: 1. Raffini L, Huang YS, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics. 2009;124(4):1001-1008. Disclosures No relevant conflicts of interest to declare.

Abstract TMP119: Incidence, Presentation and Outcomes of Brain Arteriovenous Malformations in Adult Population in United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Vamshi Balasetti ◽  
Wei Huang ◽  
Nitish Kumar ◽  
Iryna Lobanova ◽  
Farhan Siddiq ◽  
...  
Keyword(s):  
United States ◽  
Hospital Admissions ◽  
Adult Population ◽  
The United States ◽  
Severe Disability ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Diagnostic Code ◽  
Discharge Disposition ◽  
Icd 10

Background: Data regarding national estimates of brain arteriovenous malformation (BAVM) among adults in United States data are scant, often biased by limitations of single center and regional studies. Identification of such patients in nationally representative datasets was not possible until recently due to a new specific ICD-10 code. Objective: To characterize inpatient burden, expenditures, associated comorbidities (including intracerebral hemorrhages and seizures) and treatments of BAVM among adults in United States. Methods: Patients with BAVM were identified from the Nationwide Inpatient Sample (NIS) database for the year 2016 using ICD-10 diagnostic code (Q28.2). The primary outcome was to determine the prevalence of BAVM in the adult (18 and above) in-patient population in the United States. Secondary outcomes included determining inpatient mortality, morbidity, comorbidities, hospital length of stay (LOS) and total hospital charges. Outcome was classified by discharge disposition into none to minimal and moderate to severe disability. Results: Of the total 7,135,090 reported hospital discharges in 2016, an estimated 1733 (0.02%) had the diagnosis of BAVM; 1547 were adults with ages 18 or greater (mean age [SD] 54 (18); 783 (50.6%) were men). Patients with BAVM were whites (n= 921, 59.5%), African-Americans (n=224, 14.4%) and Hispanic (n=212, 13.7%). Underlying hypertension was identified in 677 (43.1%) patients. Clinical presentation was intracerebral hemorrhage (n=260, 16.8%), seizures (n=234, 15.1%) and subarachnoid hemorrhage (n=75, 4.8%). Endovascular treatment was performed in 272 (17.5%) patients and surgical treatment was performed in 45 (2.9%) patients. None to minimal disability was seen in 1023 (66.1%) and moderate to severe disability was seen in 469 (30.3%) of the patients. In hospital mortality was 2.59% (n=40). Average LOS (SD) was 4 days (8.6) with mean hospitalization charges (SD) of $121,186 (153553.1). Conclusion: There are 1547 hospital admissions for BAVM among adults in United States every year. The overall outcomes were good with high rates of none to minimal disability but the hospitalization charges were higher than expected and may be important for resource allocation.

Venous Thromboembolism Prevention Practices Among Health Care Providers Caring for Patients Hospitalized for Hematopoietic Stem Cell Transplantation: A International Web-Based Survey

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2062-2062
Author(s):  
Amer M. Zeidan ◽  
Jessica Wellman ◽  
Patrick Forde ◽  
Javier Bolaños-Meade ◽  
Michael B. Streiff
Keyword(s):  
Health Care ◽  
Stem Cell ◽  
Venous Thromboembolism ◽  
Hematopoietic Stem Cell ◽  
The United States ◽  
Bleeding Complications ◽  
Cell Transplant ◽  
Web Based ◽  
Hematopoietic Stem ◽  
Vte Prophylaxis

Abstract Abstract 2062 Background: We and others have noted that venous thromboembolism (VTE) is a common complication of hematopoietic stem cell transplant (HSCT). However, bleeding complications are even more common. Consequently, our center takes a cautious approach to VTE prevention. The purpose of this study was to determine VTE prophylaxis practice patterns among providers caring for patients during HSCT. Methods: We generated a 20 question web-based survey to determine institutional VTE prevention practices. The survey was approved by the Johns Hopkins Institutional Review Board and the American Society of Bone Marrow Transplantation (ASBMT). The survey was distributed by email by the ASBMT to its members on 6/27/2012 with 2 reminders sent at 2-week intervals. Results: A total of 114 providers from 18 countries practicing in 95 different institutions completed the survey. The majority of responders were from the United States of America (USA) (69%); but responses were received from Canada (6); Australia (5); Mexico, Spain, Germany (3 each); India, Saudi Arabia, New Zealand (2 each); and Oman, Thailand, China, Turkey, UK, Egypt, Singapore, Chile, and Croatia (1 each). The median age of responders was 47 years (standard deviation 10.3 years), and 72% were males. Ninety-one percent of respondents were board certified in hematology or oncology. One third of responders had ≥21 years of post-fellowship experience of, while 22% were within 5 years of completing fellowship training. Fifty-six percent worked in institutions performing more than 100 HSCT annually. Forty-one percent of responders described themselves as clinicians, 46% as clinical researchers, 6% as clinical educators, and 3% laboratory researchers. The majority practiced in university-affiliated or public institutions (80%).Only 32.5% and 14% of responders worked in institutions that had cancer-specific and transplant-specific VTE prophylaxis order sets, respectively. Provider preferences for VTE prevention for patients undergoing allogeneic and autologous HSCT are displayed in Figure 1. Most respondents (79%) used a platelet count threshold of 50,000/μL for pharmacologic VTE prophylaxis. Fewer respondents used 30,000/μL (19%) or 75,000/μL as a cutoff for pharmacologic VTE prophylaxis. The primary reasons cited for the current approach to VTE prevention in HSCT patients included: 1. a perceived low risk of VTE (30%), 2. a high risk of bleeding (24%), and 3. An absence of data supporting VTE prophylaxis in HSCT patients (24%). Conclusions: The first reported international web-based survey of VTE prophylaxis among health care professionals caring for HSCT patients notes considerable variation in clinical practice. These data underscore the need for further investigation to develop evidence-based recommendations for VTE prophylaxis in this vulnerable population. Disclosures: Streiff: sanofi-aventis: Consultancy, Honoraria; BristolMyersSquibb: Research Funding; Eisai: Consultancy; Janssen Healthcare: Consultancy; Daiichi-Sankyo: Consultancy.

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