Anand Brahmandam1, Marwan S Abougergi2, Cassius Iyad Ochoa Chaar3. 1. Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn. 2. Catalyst Medical Consulting, LLC, Baltimore, Md. 3. Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn. Electronic address: cassius.chaar@yale.edu.
Abstract
OBJECTIVE: The management of venous thromboembolism (VTE) has evolved during the last decade. This study sheds light on the national trends in hospital admissions, outcomes, and economic burden for VTE. METHODS: The National Inpatient Sample (NIS) was reviewed between 2003 and 2013 for hospitalizations for VTE, defined as admissions with a principal diagnosis of deep venous thrombosis (DVT) or pulmonary embolism (PE). Outcomes measured were incidence, inpatient mortality, rates of interventions, hospital length of stay (LOS), and charges. A multivariate analysis was used to identify independent predictors of mortality in patients with VTE. RESULTS: There were 3,368,409 admissions for VTE (54% female; mean age, 62.9 years), at an average of 818 per 100,000 admissions per year. Hospitalizations for PE and VTE significantly increased (P < .01), with no change for DVT (P = .13). Use of catheter-directed thrombolysis increased (0.8% to 2.7%; P < .01), with no significant change in use during the study period (P = .10). The mortality associated with hospitalizations for VTE, PE, and DVT decreased (P < .01). Mean LOS decreased from 5.79 to 4.77 days (P < .01), whereas mean hospital charges increased from $29,755 to $39,171 (P < .01). At the national level, the economic burden of VTE hospitalizations increased from $7.8 billion in 2003 to $12.1 billion in 2013 (P < .01). Older age (odds ratio [OR], 1.03), female gender (OR, 1.05), race (OR, 1.43 for Asian, 1.18 for African American, and 1.18 for Hispanic compared with white), PE (OR, 4.12), and Charlson Comorbidity Index (CCI) ≥3 (OR, 2.75) were all predictors of inpatient mortality (P < .01 for all ORs). CONCLUSIONS: Hospitalizations for VTE increased during the past decade, whereas mortality decreased. Despite a decrease in LOS, there is a rise in economic burden of VTE on the health care system.
OBJECTIVE: The management of venous thromboembolism (VTE) has evolved during the last decade. This study sheds light on the national trends in hospital admissions, outcomes, and economic burden for VTE. METHODS: The National Inpatient Sample (NIS) was reviewed between 2003 and 2013 for hospitalizations for VTE, defined as admissions with a principal diagnosis of deep venous thrombosis (DVT) or pulmonary embolism (PE). Outcomes measured were incidence, inpatient mortality, rates of interventions, hospital length of stay (LOS), and charges. A multivariate analysis was used to identify independent predictors of mortality in patients with VTE. RESULTS: There were 3,368,409 admissions for VTE (54% female; mean age, 62.9 years), at an average of 818 per 100,000 admissions per year. Hospitalizations for PE and VTE significantly increased (P < .01), with no change for DVT (P = .13). Use of catheter-directed thrombolysis increased (0.8% to 2.7%; P < .01), with no significant change in use during the study period (P = .10). The mortality associated with hospitalizations for VTE, PE, and DVT decreased (P < .01). Mean LOS decreased from 5.79 to 4.77 days (P < .01), whereas mean hospital charges increased from $29,755 to $39,171 (P < .01). At the national level, the economic burden of VTE hospitalizations increased from $7.8 billion in 2003 to $12.1 billion in 2013 (P < .01). Older age (odds ratio [OR], 1.03), female gender (OR, 1.05), race (OR, 1.43 for Asian, 1.18 for African American, and 1.18 for Hispanic compared with white), PE (OR, 4.12), and Charlson Comorbidity Index (CCI) ≥3 (OR, 2.75) were all predictors of inpatient mortality (P < .01 for all ORs). CONCLUSIONS: Hospitalizations for VTE increased during the past decade, whereas mortality decreased. Despite a decrease in LOS, there is a rise in economic burden of VTE on the health care system.