Pulmonary Vascular Disease |

Trends in Hospitalized Venous Thromboembolic Diseases in the United States FREE TO VIEW

Alita Mishra*, MD; Chapy Venkatesan, MD; Natanyah Siegel, MD; Maria Stepanova, PhD; Zobair Younossi, MD
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Department of Medicine, Inova Fairfax Hospital, Falls Church, VA

Chest. 2012;142(4_MeetingAbstracts):857A. doi:10.1378/chest.1387712
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PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM

PURPOSE: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Given increasing incidence of VTE, disease burden is growing. We evaluated trends in mortality, length of stay (LOS), and average cost for patients hospitalized for VTE

METHODS: We performed a retrospective temporal trends study using data from the Nationwide Inpatient Sample (NIS) - a large, all-payer, inpatient care database with data from nearly 8 million hospital stays per year across 44 states in the United States. Records of adult patients hospitalized with the principal diagnosis of VTE from 2005-2009 were included.

RESULTS: During 2005-2009, there were over 800,000 discharges for the principal diagnosis of VTE. In-hospital mortality decreased from 1.08% +/-0.06 in 2005 to 0.87% +/- 0.06 in 2009 (p=0.0089). LOS decreased from 5.19 +/- 0.05 days in 2005 to 4.81 +/-0.04 in 2009 (p=0). After adjustment for inflation, total cost per case showed no significant change from 2005 to 2009. The proportion of patients with extreme severity of illness by APR-DRG increased; 2.84+/-0.11 in 2005 vs. 4.72+/-0.14 in 2009 (p=0). Arterio or venogram (excluding heart or head) increased from 5.3% +/- 0.25 in 2005 to 8.05% +/-0.40 (p=0) in 2009. Other vascular catheterizations (not heart) and number of diagnoses also showed increasing trends; 3.95% +/-0.15 in 2005 vs. 5.07% +/-0.20 in 2009 (p=0) and 6.6 +/-0.06 in 2005 vs. 8.63 +/-0.08 (p=0) respectively.

CONCLUSIONS: The quality of care, measured by in-hospital mortality of patients hospitalized with the principal diagnosis of VTE, improved from 2005 to 2009. This is remarkable given increasing medical complexity signified by the number of diagnoses and severity of illness. Lengths of stay decreased, cost remained stable, and vascular studies and catheterizations increased. Potential explanations include implementation of VTE treatment guidelines and more aggressive care. Improvements in LOS may justify costs of increased studies thus keeping the overall cost stable.

CLINICAL IMPLICATIONS: Despite limitations of this observational study, implementation of VTE treatment guidelines should be encouraged and supported by hospital systems.

DISCLOSURE: The following authors have nothing to disclose: Alita Mishra, Chapy Venkatesan, Natanyah Siegel, Maria Stepanova, Zobair Younossi

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Department of Medicine, Inova Fairfax Hospital, Falls Church, VA




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