Assareh Hassan, Chen Jack, Ou Lixin, Hillman Ken, Flabouris Arthas
Epidemiology and Health Analytics, Western Sydney Local Health Districts, Gungurra Building 68, Cumberland Hospital, 5 Fleet Street, North Parramatta, 2151, NSW, Australia.
Simpson Centre for Health Services Research-South Western Sydney Clinical School Faculty of Medicine, University of New South Wales, and Ingham Institute, Sydney, Australia.
BMC Health Serv Res. 2016 Sep 22;16(1):511. doi: 10.1186/s12913-016-1766-y.
Data on hospital-acquired venous thromboembolism (HA-VTE) incidence, case fatality rate and variation amongst patient groups and health providers is lacking. We aim to explore HA-VTE incidences, associated mortality, trends and variations across all acute hospitals in New South Wales (NSW)-Australia.
A population-based study using all admitted patients (aged 18-90 with a length of stay of at least two days and not transferred to another acute care facility) in 104 NSW acute public and private hospitals during 2002-2009. Poisson mixed models were used to derive adjusted rate ratios (IRR) in presence of patient and hospital characteristics.
Amongst, 3,331,677 patients, the incidence of HA-VTE was 11.45 per 1000 patients and one in ten who developed HA-VTE died in hospital. HA-VTE incidence, initially rose, but subsequently declined, whereas case fatality rate consistently declined by 22 % over the study period. Surgical patients were 128 % (IRR = 2.28, 95 % CI: 2.19-2.38) more likely to develop HA-VTE, but had similar case fatality rates compared to medical patients. Private hospitals, in comparison to public hospitals had a higher incidence of HA-VTE (IRR = 1.76; 95 % CI: 1.42-2.18) for medical patients. However, they had a similar incidence (IRR = 0.91; 95 % CI: 0.75-1.11), but a lower mortality (IRR = 0.59; 95 % CI: 0.47-0.75) amongst surgical patients. Smaller public hospitals had a lower HA-VTE incidence rate compared to larger hospitals (IRR < 0.68) but a higher case fatality rate (IRR > 1.71). Hospitals with a lower reported HA-VTE incidence tended to have a higher HA-VTE case fatality rate.
Despite the decline in HA-VTE incidence and case fatality, there were large variations in incidents between medical and surgical patients, public and private hospitals, and different hospital groups. The causes of such differences warrant further investigation and may provide potential for targeted interventions and quality improvement initiatives.
缺乏关于医院获得性静脉血栓栓塞症（HA-VTE）发病率、病死率以及患者群体和医疗服务提供者之间差异的数据。我们旨在探讨澳大利亚新南威尔士州（NSW）所有急性医院中HA-VTE的发病率、相关死亡率、趋势及差异。
一项基于人群的研究，纳入了2002年至2009年期间新南威尔士州104家急性公立和私立医院中所有住院患者（年龄18 - 90岁，住院时间至少两天且未转至另一家急性护理机构）。使用泊松混合模型在考虑患者和医院特征的情况下得出调整后的发病率比（IRR）。
在3331677名患者中，HA-VTE的发病率为每1000名患者11.45例，每10名发生HA-VTE的患者中有1人在医院死亡。HA-VTE发病率最初上升，但随后下降，而病死率在研究期间持续下降了22%。外科患者发生HA-VTE的可能性比内科患者高128%（IRR = 2.28，95%CI：2.19 - 2.38），但病死率与内科患者相似。与公立医院相比，私立医院内科患者的HA-VTE发病率更高（IRR = 1.76；95%CI：1.42 - 2.18）。然而，私立医院外科患者的发病率与之相似（IRR = 0.91；95%CI：0.75 - 1.11），但死亡率更低（IRR = 0.59；95%CI：0.47 - 0.75）。规模较小的公立医院与规模较大的医院相比，HA-VTE发病率较低（IRR < 0.68），但病死率较高（IRR > 1.71）。报告的HA-VTE发病率较低的医院往往HA-VTE病死率较高。
尽管HA-VTE发病率和病死率有所下降，但内科和外科患者、公立和私立医院以及不同医院组之间的发病率仍存在很大差异。这些差异的原因值得进一步研究，可能为有针对性的干预措施和质量改进举措提供潜力。
