Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of morbidity and mortality in US patients hospitalized after total hip, or total knee replacement (THR, TKR) surgery. Here we evaluate the impact of VTE during initial hospitalization after THR or TKR surgery (one of the ‘never events’ as defined by Center for Medicaid and Medicare Services [CMS]) on cost of inpatient care, mortality, re-hospitalization and bleeding.
Patients who had THR or TKR surgery were identified from the 2004–2006 national Medicare claims database (one of the largest government administered plans covering almost 65% of patients who undergo THR or TKR surgery). The 1 year follow-up cost of care for patients with a VTE event during initial hospitalization was calculated. Outcome measures (mortality, bleeding, and re-hospitalization) and cost of care were compared between patients with and without a VTE event up to 30 days post-surgery.
Among the patients who underwent THR (n=93,748) and TKR (n=112,950), 1.8% had post-operative symptomatic VTE events during their initial hospitalization. Of these events, approximately 70% were DVT, 24% were PE, and 6% were both DVT and PE. More than 20% of these patients had more than two ‘never events’. Patients who had either type of surgery had worse outcomes and higher treatment cost if they suffered a post-operative VTE during initial hospitalization (Table 1). The results remained similar after multivariate regression adjustment for comorbidities and socioeconomic status.
Patients from the Medicare claims database who experienced a VTE event during their initial hospitalization had higher mortality, bleeding and re-hospitalization rates as well as higher treatment costs compared with those patients who did not develop VTE during this initial period of hospitalization.
Some patients who undergo THR or TKR surgery still develop VTE during hospitalization. In addition to relatively poor clinical outcomes, this causes an increased fiscal burden for the payor (Medicare) and patients.
Louis Kwong, Consultant fee, speaker bureau, advisory committee, etc. Johnson & Johnson; No Product/Research Disclosure Information