Real-World Analysis of the Duration of Risk of Venous Thromboembolism In US Surgical Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 479-479
Author(s):  
Alpesh N Amin ◽  
Nicole Princic ◽  
Jay Lin ◽  
Stephen Thompson ◽  
Stephen Johnston
Keyword(s):  
At Risk ◽  
Real World ◽  
Research Funding ◽  
Time Course ◽  
Cumulative Risk ◽  
Surgical Patients ◽  
Major Surgery ◽  
Index Hospitalization ◽  
Post Discharge ◽  
Pharmacological Prophylaxis

Abstract Abstract 479 Background: Patients hospitalized for major surgery are at significant risk of developing venous thromboembolism (VTE). In the US, the length of acute hospitalization for surgery has been decreasing. Given the decreased length of hospital stays, the time during which surgical patients are at risk for VTE is not well-understood in real-world clinical practice. Such information could provide insights into whether current recommendations regarding VTE prophylaxis reflect the real world needs. This retrospective, observational study assessed the incidence and time course of VTE events following admission to the hospital for major surgery in a large, real-world patient population. Methods: This study employs administrative claims data derived from the Thomson Reuters MarketScan®Inpatient Drug Link File, which comprises longitudinal patient-level inpatient and outpatient medical and pharmaceutical claims data for individuals with employer-sponsored primary or Medicare supplemental health insurance. Patients at risk for VTE due to a hospital admission between January 1, 2005, and December 31, 2008, for either abdominal or orthopedic surgery were included in this study (obtained through charge codes for types of surgical procedures that reflect the American College of Chest Physicians guideline risk groups for VTE). Patients were included if they had been continuously enrolled for at least 12 months prior to admission and at least 180 days after admission. Additionally, patients included in the analysis were required to have received some form of pharmacological prophylaxis during their hospitalization. Appropriateness of prophylaxis was not determined. The cumulative risk and hazard of VTE were established across an evaluation period of 180 days. The distribution of cumulative risk was described by the Kaplan Meier product limit method of survival analysis. The distribution of the hazard of VTE was described by a locally weighted regression procedure. The hazard function is measured as the number of VTE events per 1,000 person-days by number of days after hospital admission date to the first occurrence of VTE. Results: The study cohort consisted of 6,445 surgical patients who received prophylaxis, of whom 3,726 (57.8%) were admitted for orthopedic surgery and 2,719 (42.2%) for abdominal surgery. Patients had a mean (standard deviation [SD]) age of 64.0 (13.6) years and 63.8% were female. The mean (SD) length of stay in hospital was 5.4 (6.1) days, during which all patients received prophylaxis for VTE (criteria for inclusion) with a mean (SD) duration of 4.7 (4.3) days. 30% of patients received anticoagulation therapy within the period extending from discharge to 35 days after discharge. A total of 243 VTE events (171 DVT and 96 PE) occurred during the 180-day evaluation period. 104 (43%) VTE events occurred during the index hospitalization, and 139 (57%) VTE events occurred post-discharge. The time course of VTE events showed that the highest number of events occurred during the first 9 days (66 events, 80% in-hospital; proportion of 180-day cumulative risk ∼22%) and during days 10–19 (55 events, 58% in-hospital; proportion of 180-day cumulative risk ∼50%) following admission for the index hospitalization. VTE hazard peaked at approximately 1.4 per 1,000 person-days on the 9th day following admission for the index hospitalization. By the 21st day following index admission 50% of the cumulative 180-day risk had been incurred. The frequency of VTE then further decreased during days 20–29 (21 events, 38% in-hospital; proportion of 180-day cumulative risk ∼58%) and gradually declined thereafter, fluctuating at a background level of 1–7 events during each 10-day interval from 70–79 days up to 170–180 days. Conclusions: Over a 180-day period after admission to the hospital 243 (3.8%) out of 6,455 at-risk surgery patients receiving pharmacological prophylaxis experienced an incident VTE event. Of these VTE events, 43% occurred during the index hospitalization, while 57% occurred post-discharge. Of all VTE events that occurred within the 180-day period, a quarter occurred within 10 days and half within 3 weeks. Results from this study show that the risk of VTE was highest within the first 19 days after admission to the index hospitalization. During this high-risk period, 30% of VTE events occurred after discharge, suggesting that a non-trivial risk of VTE extends into the period after discharge. Disclosures: Amin: sanofi-aventis US Inc.: Acknowledgment: This study was funded by sanofi-aventis U.S., Inc. The authors received editorial/writing support provided by Tessa Hartog, PhD of Excerpta Medica, in the preparation of this poster funded by sanofi-aventis U.S., Inc., Honoraria, Speakers Bureau. Princic:sanofi-aventis US Inc.: Research Funding. Lin:sanofi-aventis US Inc.: Employment, Research Funding. Thompson:sanofi-aventis US Inc.: Employment. Johnston:sanofi-aventis US Inc.: Research Funding.

Real-World Analysis of Venous Thromboembolism Rates and Thromboprophylaxis Prescribing In US Patients with Cancer.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3802-3802
Author(s):  
Alpesh N Amin ◽  
Jay Lin ◽  
Stephen Thompson ◽  
Daniel Wiederkehr
Keyword(s):  
Cancer Patients ◽  
Hospital Discharge ◽  
Real World ◽  
Research Funding ◽  
Outpatient Setting ◽  
Index Hospitalization ◽  
Post Discharge ◽  
Pharmacological Prophylaxis ◽  
Mechanical Prophylaxis ◽  
Patients With Cancer

Abstract Abstract 3802 Background: Deep-vein thrombosis (DVT) is a frequent complication of cancer and treatment of cancer. Among clinical guidelines, there is broad consensus regarding the importance of thromboprophylaxis in hospitalized cancer patients, including prolonged prophylaxis in high-risk patients. The objective of this analysis was to assess the real-world use of prophylaxis for DVT, as well as symptomatic rates of DVT and pulmonary embolism (PE) in cancer patients, both during hospitalization and after hospital discharge. Methods: Data were extracted from the US Premier Perspective(tm)-i3 Pharma Informatics linked database for non-surgical cancer patients who were admitted to hospital from January 2005 to November 2007. Included patients were aged ≥ 18 years and had ≥ 6 months' continuous plan enrollment. Patients were excluded if they were discharged to an acute-care facility, had length of hospital stay ≤ 0 or > 30 days, had missing/unknown gender or age data, or if they were diagnosed with atrial fibrillation during index hospitalization. Clinical rates of DVT/PE, as well as thromboprophylaxis status and duration were evaluated for during hospitalization and post-discharge. Results: Of the 3,759 cancer patients analyzed, 51.9% received inpatient pharmacological and/or mechanical prophylaxis, and 2.8% received outpatient pharmacological prophylaxis in the 14 days following discharge. During index hospitalization 40.0% of patients received mechanical prophylaxis and 21.1% pharmacological prophylaxis, with 9.3% of patients receiving a combination of mechanical and pharmacological prophylaxis. Mean (± standard deviation) duration of prophylaxis was 1.3 (± 2.3) days for inpatients and 0.7 (± 4.5) days post-discharge among all cancer patients. Symptomatic DVT/PE occurred in 2.4% of patients during hospitalization. In the 30 days following hospital discharge, 1.7% of patients was either rehospitalized for DVT/PE or treated for DVT/PE in the outpatient setting. Conclusions: This real-world analysis demonstrates considerable symptomatic rates of DVT/PE in hospitalized cancer patients, with approximately half of patients not receiving any thromboprophylaxis. The risk of DVT/PE persisted into the outpatient setting, but few patients received anticoagulants post-discharge. Further efforts are needed to ensure that patients with cancer receive appropriate thromboprophylaxis and that it is of adequate duration to reduce the large burden of DVT/PE. Acknowledgment: This study was funded by sanofi-aventis U.S., Inc. The authors received editorial/writing support in the preparation of this abstract provided by Tessa Hartog, PhD of Excerpta Medica, funded by sanofi-aventis U.S., Inc. Disclosures: Amin: sanofi-aventis US Inc.: Honoraria, Speakers Bureau. Lin:sanofi-aventis US Inc.: Employment, Research Funding. Thompson:sanofi-aventis US Inc.: Employment. Wiederkehr:sanofi-aventis US Inc.: Research Funding.

Venous Thromboembolism Risk and Prophylaxis Practices in Surgical Patients with Active Cancer: Findings from the Global ENDORSE Survey.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 984-984 ◽  
Author(s):  
Ajay K Kakkar ◽  
Alexander T Cohen ◽  
Victor F Tapson ◽  
Jean-Francois Bergmann ◽  
Samuel Z. Goldhaber ◽  
...  
Keyword(s):  
At Risk ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Bleeding Risk ◽  
Surgical Patients ◽  
Major Surgery ◽  
Gynecological Surgery ◽  
Vte Prophylaxis ◽  
Surgery Patient ◽  
Anticoagulant Prophylaxis

Abstract Introduction : Cancer patients undergoing surgery have double the risk for VTE compared with non-cancer patients (Thromb Haemost2003;90:446–55). Current ACCP guidelines advocate the use of VTE prophylaxis in patients with active malignancy undergoing major surgical procedures. The recent ENDORSE survey reported that globally, 64% of patients admitted to surgical wards were at risk for VTE, and only 59% of these received ACCP-recommended prophylaxis (Lancet2008;371:387–94). In this subanalysis of ENDORSE, we evaluated the prevalence of VTE risk and prophylaxis practices in surgical patients with active malignancy. Methods: The ENDORSE study evaluated data from 30,827 patients admitted to surgical wards in 358 hospitals across 32 countries (Lancet2008;371:387–94). The influence of active malignancy on VTE risk and prophylaxis use was assessed in patients who had undergone abdominal, urological or gynecological surgery. Patient data were grouped and analyzed according to whether the surgery was related to a cancer diagnosis (surgery for cancer) or performed in patients without a cancer diagnosis (no cancer). Risk for VTE and use of appropriate prophylaxis was evaluated according to the 2004 ACCP-guidelines (Chest2004;126:338S–400S). Bleeding risk factors considered sufficient to present a contraindication to anticoagulant use included intracranial hemorrhage, bleeding at hospital admission, presence of a known bleeding disorder and clinically relevant hepatic impairment. Results: Of the 30,827 patients in surgical wards evaluated in ENDORSE, 18,461 had undergone major surgery as of the date of the survey, including 6172 patients who had abdominal, urological or gynecological operations and were considered at risk for VTE. All patients with a cancer diagnosis who underwent these types of surgery were considered at-risk for VTE, including 1767 patients whose surgical procedure was related to their diagnosis and 101 patients who underwent surgery unrelated to cancer. The proportion of patients receiving any ACCP-recommended prophylaxis ranged from 60% in patients undergoing surgery for urologic cancer to 86% in patients undergoing surgery for rectosigmoid cancer. Patients who had surgery related to their cancer had a higher rate of ACCP-recommended prophylaxis use, compared with patients who underwent surgery with no cancer diagnosis (Table). The proportion of patients considered to have bleeding risk sufficient to present a contraindication to anticoagulant use was 10.4% (surgery for cancer) and 10.9% (no cancer; Table). Fewer patients without a cancer diagnosis received anticoagulant prophylaxis, compared with those undergoing cancer-related surgery (Table). Table: VTE prophylaxis practice according to the presence of active malignancy. Surgery type At-risk receiving ACCP-recommendedprophylaxis n/N (%) Contrain-dications to anticoagulant use, n (%) Anticoagulant alone, n (%) Mechanical alone, n (%) Both, n (%) *4304 of 5097 patients without a cancer diagnosis were considered at risk for VTE Surgery for cancer (N=1767) 1295/1767 (73.3) 183 (10.4) 820 (46.4) 136 (7.7) 412 (23.3) No cancer (N=5097) 2495/4304* (58.0) 470 (10.9) 1455 (33.8) 426 (9.9) 762 (17.7) Conclusion: The use of any type of ACCP-recommended VTE prophylaxis varied according to the type of cancer for which the surgery was performed. Although all cancer patients who undergo abdominal, urological or gynecological surgery are at risk for VTE, the results suggest that up to 30% of cancer patients where surgery is performed related to a cancer diagnosis do not receive ACCP-recommended prophylaxis. Less than 11% of patients who had surgery regardless of whether it was related to a cancer diagnosis had a bleeding risk sufficient to present a contraindication to anticoagulant use. These findings suggest that despite the existence of clear evidence-based guidelines, the use of VTE prophylaxis in cancer patients remains suboptimal.

VTE Prophylaxis Across the Continuum of Care in US Orthopedic Surgery Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2097-2097
Author(s):  
Alpesh Amin ◽  
Jay Lin ◽  
Amy Ryan
Keyword(s):  
At Risk ◽  
Orthopedic Surgery ◽  
Research Funding ◽  
Significant Risk ◽  
Post Discharge ◽  
Vte Prophylaxis ◽  
Individual Patient Level ◽  
Hip Fracture Surgery ◽  
Major Orthopedic Surgery ◽  
Patients At Risk

Abstract Abstract 2097 Poster Board II-74 Background: Patients who undergo major orthopedic surgery are at significant risk of developing VTE. As 40-60% of orthopedic surgery patients develop VTE in the absence of thromboprophylaxis, evidence-based guidelines recommend pharmacological VTE prophylaxis in all patients without contraindications. As the risk of VTE persists beyond discharge in these patients, the use of LMWH and warfarin post-discharge is both suitable and recommended. However, a lack of awareness and education often leads to an absence of VTE prophylaxis post-discharge. This analysis evaluated in-hospital and post-discharge VTE prophylaxis patterns for US orthopedic surgery patients. Methods: Premier's Perspective” inpatient data were cross-matched at the individual patient level with Ingenix LabRx® outpatient data from the I3 database (January 2005-December 2007) to assess VTE prophylaxis patterns in major orthopedic surgery (total knee arthroplasty, total hip arthroplasty, hip fracture surgery) patients at risk of VTE (according to the American College of Chest Physicians 2004 guidelines) and with no contraindications for anticoagulation. Inpatients were assessed for the anticoagulant received in-hospital and were followed post-discharge to assess their outpatient prophylaxis use. Drug utilization and clinical practice patterns during and within 30 days after hospitalization were collected and compared descriptively between groups. Results: Of the 3,311 orthopedic surgery discharges at risk of VTE and included in this analysis, only 295 (8.9%) did not receive any anticoagulation at all. Of the remaining 3,016 (91.1%) discharges that did receive anticoagulation, 1,061 (35.2%) received enoxaparin, 1,028 (34.1%) received warfarin, and the remaining 927 (30.7%) received other or combination prophylaxis. However, after discharge only 1,800 (54.4%) of all patients received prophylaxis, with the majority receiving warfarin (1,028, 57.1%). The remaining 1,511 (45.6%) received no outpatient prophylaxis (Table). Conclusion: This analysis presents both inpatient and outpatient VTE prophylaxis patterns in real-world orthopedic surgery patients that are at risk of VTE. Although the rate of prophylaxis was high in inpatients, approximately half of all patients had no prophylaxis post-discharge. Further efforts to improve VTE prevention in discharged orthopedic surgery patients are required. Disclosures: Amin: sanofi-aventis: Research Funding, Speakers Bureau, The authors received editorial/writing support in the preparation of this abstract funded by sanofi-aventis U.S., Inc. . Lin:sanofi-aventis: Employment. Ryan:sanofi-aventis: Research Funding.

VTE Prophylaxis Across the Continuum of Care in US Medical Patients at Risk of Venous Thromboembolism.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1386-1386
Author(s):  
Alpesh Amin ◽  
Jay Lin ◽  
Amy Ryan
Keyword(s):  
At Risk ◽  
Research Funding ◽  
Medical Patients ◽  
Post Discharge ◽  
Vte Prophylaxis ◽  
Individual Patient Level ◽  
Patients At Risk ◽  
The Individual ◽  
Severe Lung Disease ◽  
The Continuum

Abstract Abstract 1386 Poster Board I-408 Background: Medical patients with chronic medical illnesses are often at risk of VTE both in-hospital and post-discharge. However, although injectable prophylaxis options are available and suitable for providing in-hospital and post-discharge prophylaxis, there is often a lack of continuity in VTE post-discharge prophylaxis. This analysis evaluated in-hospital and post-discharge VTE prophylaxis patterns for US medical patients. Methods: Premier's Perspective™ inpatient data were cross-matched at the individual patient level with Ingenix LabRx® outpatient data from the I3 database (January 2005-December 2007) to assess VTE prophylaxis patterns in medical patients (cancer without surgery, heart failure, severe lung disease, infectious disease) at risk of VTE (according to the American College of Chest Physicians 2004 guidelines) and with no contraindications for anticoagulation. Inpatients were assessed for any anticoagulation received in-hospital and were followed post-discharge to assess their outpatient prophylaxis use. Drug utilization and clinical practice patterns during and within 30 days after hospitalization were collected and compared descriptively between groups. Results: Of the 9,675 medical discharges at risk of VTE and included in this analysis, 6,185 (63.9%) did not receive any anticoagulation at all. Of the remaining 3,490 (36.1%) discharges that did receive anticoagulation, 2,045 (58.6%) received enoxaparin and 1,044 (29.9%) received unfractionated heparin (UFH) (Table). After discharge, 98.2% of all patients did not receive any prophylaxis within the following 30 days. Only 174 (1.8%) discharges received outpatient prophylaxis, with 67.8% receiving warfarin alone and 18.4% receiving enoxaparin and warfarin (Table). Conclusion: This analysis presents both inpatient and outpatient VTE prophylaxis patterns in real-world medical patients that are at risk of VTE. Nearly 64% of patients received no inpatient VTE prophylaxis, and less than 2% received outpatient prophylaxis. Further efforts to improve VTE prevention in hospitalized patients are required, with particular emphasis needed on the transition to outpatient prophylaxis. Disclosures: Amin: sanofi-aventis: Research Funding, Speakers Bureau, The authors received editorial/writing support in the preparation of this abstract funded by sanofi-aventis U.S., Inc.. Lin: sanofi-aventis: Employment. Ryan: sanofi-aventis: Research Funding.

Venous Thromboembolism Following Major Surgery and Risk of Recurrence: A Population-Based Cohort Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5243-5243
Author(s):  
Dimple Kondal ◽  
Susan R. Kahn ◽  
Vicky Tagalakis
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
General Surgery ◽  
Research Funding ◽  
Population Based ◽  
Major Surgery ◽  
Adjusted Relative Risk ◽  
Post Discharge ◽  
Risk Of Recurrence ◽  
The Mean

Abstract Abstract 5243 Background: Venous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) is a common complication of major surgery. Little is known of the risk of recurrent VTE following postoperative VTE. Objectives: We used the administrative health claims (RAMQ) and hospital discharge (MED ECHO) databases of Quebec, Canada to conduct a population-based retrospective cohort study to describe the time to VTE following general surgery and to assess the risk of VTE recurrence among patients with surgery-provoked VTE. Methods: Using a previously defined cohort of individuals who had a first-time discharge diagnosis of VTE between January 1996 and December 2004 in MED ECHO, which systematically records information on all hospital admissions in the province of Quebec, we identified patients who had undergone major surgery in the 3 months prior to the VTE. Subjects were followed from the time of incident VTE until first VTE recurrence, death, or end of study (December 31, 2005). Results: Our study population consisted of 9629 patients with new VTE up to 3 months following major surgery. The mean age was 63.9 years (SD=15.2) and 53% were female. General surgery (32%) was the most common procedure. The mean time to VTE after surgery was 29.5 days (SD=62.6) with 30% of events diagnosed after discharge. The 5-year adjusted cumulative risk of recurrence was 7.9%. Patients with VTE diagnosed after discharge had an adjusted relative risk of recurrence of 1.43 (95% confidence interval (1.21, 1.69)) compared to patients with VTE diagnosed before discharge. Conclusions: Our results suggest that surgery-provoked VTE occurs frequently after discharge and is associated with an elevated risk of recurrence, and that patients with post-discharge VTE are at a higher risk of recurrence than patients with VTE diagnosed before discharge. Thromboprophylaxis strategies post-discharge should be considered in this population. Disclosures: Tagalakis: Sanofi Aventis: Research Funding; Pfizer: Research Funding.

Abstract P267: Healthcare Resource Utilization and Costs of US Patients With Possible Large Hemispheric Infarction: A Real-World Assessment of Burden Associated With Cerebral Edema

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nicole Tsao ◽  
Qiang Hou ◽  
Shih-Yin Chen ◽  
Steven MESSE
Keyword(s):  
Resource Utilization ◽  
Cerebral Edema ◽  
Resource Use ◽  
Real World ◽  
Linear Models ◽  
Healthcare Resource ◽  
Cerebral Arteries ◽  
Index Hospitalization ◽  
Post Discharge ◽  
Hemispheric Infarction

Introduction: Severe cerebral edema further compromises survival and functional outcomes in patients suffering from large hemispheric infarction (LHI). This study aims to compare the healthcare resource use and costs during the acute hospitalization and post-discharge, in a cohort of US patients with possible LHI with and without cerebral edema (CED). Methods: Using IBM MarketScan Commercial, Medicaid, and Medicare databases (2016Q1-2018Q4), a cohort of patients aged 18-85 were identified using ICD10 codes for hospitalization due to occlusion of the carotid or middle cerebral arteries, which are most closely associated with LHI. We classified patients with ICD10 codes G93.5 (compression of brain), G93.6 (cerebral edema), or a craniectomy procedure as having had CED. In addition to the inpatient resource use and outcomes, annualized frequency of resource utilization and costs during the follow-up period were reported in those who survived and continued to be enrolled in their health plan post-index hospitalization. Logistic regression was used to estimate the odds ratio of mortality, generalized linear models for mean in healthcare utilization and costs between those with and without CED, adjusting for age, sex, and comorbidity. Results: Of the 7,336 commercial, 1,946 Medicaid, and 5,015 Medicare patients with possible LHI, we found 7.8%, 6.9%, and 4.3% had CED, respectively. Those with CED had higher length of stay, mortality, and costs during the index hospitalization across the populations examined (Table). CED was also consistently associated with higher post-discharge resource utilization and costs in the commercially-insured population (Table). Conclusions: This real-world evidence from private and public health plans highlights the substantial clinical and economic burden during the index hospitalization and post-discharge in patients who develop cerebral edema after LHI.

Healthcare-associated urinary tract infections with onset post hospital discharge

2019 ◽  
Vol 40 (8) ◽  
pp. 863-871 ◽  
Author(s):  
Miriam R. Elman ◽  
Craig D. Williams ◽  
David T. Bearden ◽  
John M. Townes ◽  
John D. Heintzman ◽  
...  
Keyword(s):  
At Risk ◽  
Urinary Tract ◽  
Hospital Discharge ◽  
Retrospective Cohort ◽  
Private Insurance ◽  
Antibiotic Prescribing ◽  
Index Hospitalization ◽  
Post Discharge ◽  
Tract Infections ◽  
Healthcare Associated

AbstractObjective:Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.Design:Retrospective cohort study.Setting:Academic, quaternary care, referral center.Patients:Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.Methods:Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.Results:We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.2–18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95% CI, 1.0–2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95% CI, 1.1–4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1.0–2.8), and private insurance (aOR, 0.6; 95% CI, 0.4–0.9).Conclusions:HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.

Evaluating the Performance of a Previously Reported Risk Score To Predict Venous Thromboembolism: A VERITY Registry Study.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 716-716 ◽  
Author(s):  
Denise O’Shaughnessy ◽  
Peter Rose ◽  
Fran Pressley ◽  
Nicholas Scriven ◽  
Tim Farren ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Risk Score ◽  
Hormone Replacement ◽  
Cumulative Risk ◽  
Final Diagnosis ◽  
Major Surgery ◽  
Study Cohort ◽  
Hospitalised Patients ◽  
Increased Risk

Abstract Accurate prediction of venous thromboembolic (VTE) risk remains a clinical challenge, and no prospectively validated risk scoring systems have been described. Recently, a computer-based alert to highlight hospitalised patients at risk of VTE that employed a simple risk score based on eight principal VTE risk factors was shown to improve patient outcome (N Engl J Med2005;352:969–977). The objective of this study was to assess the performance of this risk score in identifying those at risk of VTE. The study cohort consisted of all patients who were enrolled in ‘VERITY’ up to 30th November, 2004. VERITY is a UK, prospective VTE treatment registry that enrolls patients presenting to hospital with suspected VTE (www.verityonline.co.uk). The vast majority of patients enrolled have no history of hospitalization and therefore patients will not have been risk assessed or have been given thromboprophylaxis, so essentially reflecting an untreated population. The risk score was applied to the patient database and a score calculated for each patient for whom all 8 risk factors were known. Risk was scored as previously described: score=3 for cancer, prior VTE, hypercoagulability; score=2 for major surgery; score=1 for age>70 years, BMI>29, bed rest not related to surgery, use of hormone-replacement therapy or oral contraceptives. An increased risk was defined as a cumulative risk score of at least 4. Of 27,179 patients presenting with suspected VTE, 6,124 had a positive diagnosis of deep vein thrombosis, pulmonary embolism, or both; in 15,980 cases the diagnosis was not confirmed. All 8 risk factors were known for 5,692 cases (1880 with confirmed VTE [31%] and 3812 VTE-negative cases [24%]). An increasing risk score was associated with an approximately linear rise in the proportion of patients with confirmed VTE; more than 50% of patients with a risk score ≥4 were diagnosed with VTE, rising to more than 71% in those with a score >7 (see figure). Although this patient cohort is not identical to the population the risk score was developed for, these data suggest the value of this weighted risk score in identifying those at risk of VTE. Further refinement of this score, perhaps using more sophisticated modeling to increase the accuracy of the score to predict thromboembolic events, would be highly valuable for routine integration of VTE assessment into clinical practice. Final diagnosis of VTE and weighted risk score (n=5,692) Final diagnosis of VTE and weighted risk score (n=5,692)

Impact of Surgery Type and Co-Morbidities on Venous Thromboembolism prophylaxis Practices in Patients Undergoing Major Surgical Procedures in Acute Care Hospitals Worldwide: A Subanalysis of Data from the ENDORSE Survey

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 171-171 ◽  
Author(s):  
Ajay K Kakkar ◽  
Alexander T Cohen ◽  
Victor F Tapson ◽  
Jean-Francois Bergmann ◽  
Samuel Z. Goldhaber ◽  
...  
Keyword(s):  
At Risk ◽  
Hip Replacement ◽  
Multivariable Analysis ◽  
Surgical Patients ◽  
Major Surgery ◽  
Vte Prophylaxis ◽  
Factors Associated ◽  
Major Orthopedic Surgery ◽  
Patients At Risk ◽  
To Receive

Abstract Introduction: Despite the publication of international consensus guidelines for the provision of venous thromboembolism (VTE) prophylaxis, the recent ENDORSE survey reported that 64% of patients admitted to surgical wards in hospitals worldwide are at risk for VTE, and of those only 59% received appropriate prophylaxis (Lancet2008;371:387–94). In this sub-analysis of ENDORSE data, we assess the provision of VTE prophylaxis according to surgery type, and evaluate the key factors associated with the decision to provide VTE prophylaxis to surgical patients. Methods: ENDORSE was a multinational, cross-sectional survey of patients admitted to medical and surgical wards in 358 hospitals across 32 countries (Lancet2008;371:387–94). VTE risk and prophylaxis use were assessed in evaluable patients according to the 2004 American College of Chest Physicians (ACCP) guidelines (Chest2004;126:338S–400S). Major surgery was grouped into the following categories: major orthopedic (hip replacement, knee replacement, hip fracture repair); abdominal/thoracic (colon/small bowel, rectosigmoid, gastric, hepatobiliary, thoracic); vascular; urological/gynecological; and other (curative arthroscopy, other orthopedic trauma, other surgeries). Independent factors associated with the use of ACCP-recommended prophylaxis in surgical patients at risk for VTE were evaluated using multivariable logistic regression analyses. Results: Of the 30,827 patients in surgical wards included in ENDORSE, 18,461 had undergone major surgery as of the date of the survey. Of these, 17,018 (92.2%) were considered to be at risk for VTE, although only 10,710 (58.0%) received ACCP-recommended types of VTE prophylaxis. The proportion of patients at risk for VTE and the use of ACCP-recommended prophylaxis varied according to surgery type (Table). Multivariable analysis confirmed that surgery type was the factor that was most strongly associated with the provision of ACCP-recommended VTE prophylaxis. Patients undergoing major orthopedic surgery were most likely to receive recommended VTE prophylaxis, with patients undergoing hip replacement surgery 6 times more likely to receive ACCP- prophylaxis (OR 6.2; 95% CI 5.0–7.9). Curative arthroscopy and rectosigmoid surgery were also strongly associated with the provision of ACCP-recommended prophylaxis: (OR 3.6; 95% CI 2.3–5.4 and OR 2.3; 95% CI 1.7–3.0, respectively). When surgery type was excluded from the multivariable analysis, obesity (OR 1.9; 95% CI 1.7–2.1), rheumatologic or inflammatory disease (OR 1.7; 95% CI 1.3– 2.2), and previous VTE (OR 1.7; 95% CI 1.3–2.1) were the clinical characteristics most strongly associated with the use of recommended VTE prophylaxis. Conclusion: The provision of ACCP-recommended VTE prophylaxis was primarily driven by the fact that patients underwent a major operation and rates of prophylaxis use varied substantially according to the type of surgery. Patients undergoing major orthopedic surgery are most likely to receive appropriate VTE prophylaxis, however up to 45% of at-risk patients undergoing non-orthopedic procedures do not receive ACCP-recommended prophylaxis. Surgery type was the most important factor associated with the decision to provide ACCP-recommended prophylaxis in surgical patients at risk for VTE. Table: Prevalence of VTE risk and use of ACCP-recommended prophylaxis according to surgery type. Surgery type N Patients at risk For VTE n (%) At-risk receiving ACCP-Recommended prophylaxisn (%) Major orthopedic 2300 2300 (100) 1979 (86.0) Abdominal/thoracic 5028 4527 (90.0) 3023 (66.8) Vascular 1038 946 (91.1) 676 (71.5) Urological/gynecological 2653 2344 (88.4) 1261 (53.8) Other 7442 6901 (92.7) 3771 (54.6)

Real-World VTE Prophylaxis Practices in US Orthopedic Surgery Patients: An Analysis of An Integrated Healthcare Database.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1075-1075
Author(s):  
Geno J Merli ◽  
Elisabetta Malangone ◽  
Jay Lin ◽  
Lee Stern
Keyword(s):  
Molecular Weight ◽  
Real World ◽  
Orthopedic Surgery ◽  
Research Funding ◽  
Average Length ◽  
Low Molecular Weight ◽  
Pharmacological Prophylaxis ◽  
Vte Prophylaxis ◽  
Major Orthopedic Surgery ◽  
Prophylaxis Therapy

Abstract Abstract 1075 Poster Board I-97 Introduction: Major orthopedic surgery patients are at high risk of venous thromboembolism (VTE), with a VTE incidence of 40-60% in patients that do not receive thromboprophylaxis. However, the incidence of VTE can be significantly reduced with the use of evidence-based thromboprophylaxis such as low-molecular-weight heparins (LMWH) and warfarin. Although prophylaxis is often provided in-hospital, there is frequently a break in the continuum of VTE prophylaxis on discharge, despite the applicability of LMWH or warfarin for outpatient prophylaxis. The purpose of this study is to describe real-world inpatient and outpatient pharmacological prophylaxis practices of patients undergoing major orthopedic surgery. Methods: Patients greater than 18 years of age in a large, vertically integrated Midwestern healthcare system (January 1995 to June 2008) and with a Current Procedural Terminology (CPT) code for predetermined knee and hip orthopedic surgeries were eligible for this study. Patients with atrial fibrillation or less than 18 months of continuous health plan enrollment (including a minimum of 1-year post-discharge) were excluded from the analyses. Prophylaxis therapy was assessed during the first year of follow-up and stratified by inpatient versus outpatient therapy. Characteristics of prophylaxis use, such as anticoagulation duration, prophylaxis type stratified by surgery, and mean INR were also examined. Results: A total of 2382 patients were included in the analysis, with 1393 (58.5%) undergoing total knee arthroplasty (TKA) and 989 (41.5%) undergoing total hip arthroplasty (THA). The average length of hospital stay was 4.7 days in TKA patients and 5.1 days in THA patients. When considering prophylaxis use, 72.7% of TKA patients received inpatient pharmacological prophylaxis alone, 12.5% received inpatient and outpatient pharmacological prophylaxis, 3.5% received only outpatient pharmacological prophylaxis and 11.3% received no pharmacological prophylaxis (Table). Similarly in THA patients, 73.2% received inpatient pharmacological prophylaxis alone, 12.4% received inpatient and outpatient pharmacological prophylaxis, 3.2% received only outpatient pharmacological prophylaxis and 10.9% received no pharmacological prophylaxis. In both TKA and THA patients, the most frequent inpatient prophylaxis therapy was low-molecular-weight heparin (90.6% and 85.6%, respectively). In those patients that received warfarin, the majority (67.9%) had a mean INR between 1 and 2 during the first 2 months. Conclusions: This analysis highlights the short duration of prophylaxis provided to US orthopedic surgery patients. Despite these patients having mean hospital stays of approximately 5 days and guidelines recommending a minimum of 10 days of prophylaxis for major orthopedic surgery patients, only approximately 15% of patients received outpatient prophylaxis. Disclosures: Merli: sanofi-aventis: Consultancy, Research Funding, Speakers Bureau, The authors received editorial/writing support in the preparation of this abstract funded by sanofi-aventis U.S., Inc.; AstraZeneca: Consultancy, Research Funding, Speakers Bureau; Boehringer Ingelheim: Research Funding; Bayer: Consultancy; Bacchus Scientific: Consultancy. Malangone:sanofi-aventis: Research Funding. Lin:sanofi-aventis: Employment. Stern:sanofi-aventis: Research Funding.

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