Khanna Raman, Maynard Gregory, Sadeghi Banafsheh, Hensley Laurie, Medvedev Sofia, Danielsen Beate, White Richard H
Department of Medicine, University of California San Francisco, San Francisco, California.
J Hosp Med. 2014 Apr;9(4):221-5. doi: 10.1002/jhm.2159. Epub 2014 Feb 5.
Hospital-acquired venous thromboembolism (HA-VTE, VTE occurring during a hospitalization) codes in hospital billing data are often used as a surrogate for hospital-associated VTE events occurring during or up to 30 days after a hospitalization, which are more difficult to measure.
Establish the incidence and composition of HA-VTE/superficial venous thrombosis (SVT) coded in a large cohort of medical patients.
Retrospective analysis of discharges.
Eighty-three academic medical centers in UHC (formerly University HealthSystem Consortium).
Patients with medical diagnoses hospitalized >2 days between October 1, 2009, and March 31, 2011.
Incidence and anatomic location of HA-VTE codes, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for VTE coupled to a present-on-admission indicator flag set to "No."
Among 2,525,068 medical hospitalizations, 12,847 (0.51%) cases had ≥1 thrombotic code; 2449 (19.1%) with pulmonary embolism (PE), and 3848 (30%) with lower-extremity deep venous thrombosis (LE-DVT) without PE. Upper-extremity DVT (2893; 22.5%) and SVT (3248; 25.3%) comprised the bulk of remaining cases. Among cases with HA-PE/LE-DVT, 34.3% had cancer, 47.8% received care in an intensive care unit, 78% had severe or extreme severity of illness, and 16.5% died in the hospital. Overall, 54.9% of the patients who developed a HA-PE/LE-DVT had been started on VTE pharmacoprophylaxis on hospital day 1 or 2.
At academic centers, HA-VTE/SVT is coded in 0.51% of medical inpatients, and HA-PE/LE-DVT is coded in half of those. Most patients with HA-PE/LE-DVT are severely ill and develop VTE despite receiving prophylaxis.
医院计费数据中的医院获得性静脉血栓栓塞症（HA-VTE，住院期间发生的VTE）编码常被用作住院期间或住院后30天内发生的医院相关VTE事件的替代指标，而这些事件更难测量。
确定一大群内科患者中编码的HA-VTE/浅静脉血栓形成（SVT）的发病率和构成。
出院情况的回顾性分析。
UHC（原大学卫生系统联盟）的83家学术医疗中心。
2009年10月1日至2011年3月31日期间住院时间超过2天的内科诊断患者。
HA-VTE编码的发病率和解剖位置，定义为国际疾病分类第九版临床修订版中与入院时指标标记设置为“否”的VTE相关的编码。
在2525068例内科住院病例中，12847例（0.51%）有≥1个血栓形成编码；2449例（19.1%）为肺栓塞（PE），3848例（30%）为无PE的下肢深静脉血栓形成（LE-DVT）。上肢DVT（2893例；22.5%）和SVT（3248例；25.3%）占其余病例的大部分。在HA-PE/LE-DVT病例中，34.3%患有癌症，47.8%在重症监护病房接受治疗，78%病情严重或极其严重，16.5%在医院死亡。总体而言，发生HA-PE/LE-DVT的患者中，54.9%在住院第1天或第2天开始接受VTE药物预防。
在学术中心，0.51%的内科住院患者有HA-VTE/SVT编码，其中一半有HA-PE/LE-DVT编码。大多数HA-PE/LE-DVT患者病情严重，尽管接受了预防仍发生VTE。
