Cost of venous thromboembolism following major orthopedic surgery in hospitalized patients.

The economic costs of clinical venous thromboembolism (VTE) in hospitalized patients after major orthopedic surgery were assessed. The discharge summaries and itemized bills from 220 U.S. acute care hospitals were examined. All patients who underwent total hip or knee replacement surgery or hip-fracture repair at these hospitals between January 1998 and June 1999 were identified and included in the study sample. Length of hospital stay, use of intensive care services, and costs of inpatient care were compared between patients with and without secondary diagnoses of deep vein thrombosis (DVT) without pulmonary embolism (PE) (DVT only) or PE with or without DVT. Mean length of hospital stay was more than twice as long for patients with VTE (11.5 and 12.4 days for DVT only and PE, respectively, versus 5.4 days for no VTE; p < 0.0001 for both comparisons). Mean time in the intensive care unit was roughly 10-fold greater (1.7 days for DVT only and 2.7 days for PE versus 0.2 day for no VTE; p < 0.0001). Mean total costs of inpatient care were almost twofold higher for patients with VTE ($17,114 for DVT only and $18,521 for PE versus $9,345 for no VTE; p < 0.0001 for both comparisons). Findings were unchanged in multivariate analyses controlling for differences in baseline characteristics between patients with and without VTE. Patients who develop in-hospital clinical VTE following major orthopedic surgery have significantly longer stays in the 'hospital and approximately twofold higher costs of inpatient care.