Oster Gerry, Ollendorf Daniel A, Vera-Llonch Montserrat, Hagiwara May, Berger Ariel, Edelsberg John
Policy Analysis Inc., Brookline, MA 02445-7629, USA.
Ann Pharmacother. 2004 Mar;38(3):377-82. doi: 10.1345/aph.1C518. Epub 2004 Jan 12.
Venous thromboembolism (VTE) is a frequent and potentially costly complication of major orthopedic surgery.
To estimate the economic consequences of VTE following major orthopedic surgery.
Using a large healthcare claims database, we identified all patients who underwent total hip replacement, major knee surgery, or hip fracture repair from January 1993 to December 1998. Patients with clinical VTE (cases) were identified based on a diagnosis of deep vein thrombosis or pulmonary embolism within 90 days of surgery (index admission) and > or =1 prescription for warfarin or unfractionated heparin within 30 days of the date of initial VTE diagnosis. Each case was matched (using age and procedure type) to 2 randomly selected patients who did not have any claims for clinical VTE (matched controls). Utilization and billed charges were then examined over a 90-day period following admission. Cases were stratified based on whether VTE was first noted during the index admission or thereafter.
A total of 11 960 patients were identified who underwent total hip replacement, major knee surgery, or hip fracture repair (n = 3171, 3955, 4834, respectively). Over a 90-day period, 259 patients (2.2%) developed clinical VTE. Most cases (61.8%) occurred after hospital discharge. For patients with in-hospital VTE, mean length of stay for the index admission was 4.5 days longer than that of matched controls (11.1 vs 6.6); by day 90, there was a 5.4-day difference in total hospital days. Mean billed charges for the index admission were 17,552 higher US dollars (52,037 US dollars vs 34,485 US dollars); the difference rose to 18,834 US dollars by day 90 (54,480 US dollars vs 35,646 US dollars). For patients who developed clinical VTE following hospital discharge, there was a 3.4-day difference in total hospital days at day 90 (10.2 vs 6.8) as a result of readmissions for VTE; mean total billed charges at day 90 were 5765 US dollars higher (41,411 US dollars vs 35,646 US dollars).
Among patients who have undergone major orthopedic surgery, the economic consequences of VTE are substantial, regardless of the setting in which it occurs.
静脉血栓栓塞症（VTE）是大型骨科手术常见且可能代价高昂的并发症。
评估大型骨科手术后VTE的经济后果。
利用一个大型医疗保健理赔数据库，我们确定了1993年1月至1998年12月期间接受全髋关节置换术、大型膝关节手术或髋部骨折修复术的所有患者。临床VTE患者（病例组）根据手术（首次住院）后90天内深静脉血栓形成或肺栓塞的诊断以及首次VTE诊断日期后30天内≥1次华法林或普通肝素处方来确定。每个病例（根据年龄和手术类型）与2名随机选择的无临床VTE理赔记录的患者（匹配对照组）进行匹配。然后在入院后的90天内检查其医疗利用情况和计费费用。病例根据VTE是否在首次住院期间首次发现进行分层。
共确定了11960例接受全髋关节置换术、大型膝关节手术或髋部骨折修复术的患者（分别为3171例、3955例、4834例）。在90天期间，259例患者（2.2%）发生了临床VTE。大多数病例（61.8%）发生在出院后。对于住院期间发生VTE的患者，首次住院的平均住院时间比匹配对照组长4.5天（11.1天对6.6天）；到第90天，总住院天数相差5.4天。首次住院的平均计费费用高出17552美元（52037美元对34485美元）；到第90天，差异增至18834美元（54480美元对35646美元）。对于出院后发生临床VTE的患者，由于VTE再次入院，第90天的总住院天数相差3.4天（10.2天对6.8天）；第90天的平均总计费费用高出5765美元（41411美元对35646美元）。
在接受大型骨科手术的患者中，VTE的经济后果是巨大的，无论其发生在何种情况下。
