Incidence of hospital-acquired venous thromboembolic codes in medical patients hospitalized in academic medical centers

Raman Khanna, Gregory Maynard, Banafsheh Sadeghi, Laurie Hensley, Sofia Medvedev, Beate Danielsen, Richard H White

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND: 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. OBJECTIVE: Establish the incidence and composition of HA-VTE/superficial venous thrombosis (SVT) coded in a large cohort of medical patients. DESIGN: Retrospective analysis of discharges. SETTING: Eighty-three academic medical centers in UHC (formerly University HealthSystem Consortium). PATIENTS: Patients with medical diagnoses hospitalized >2 days between October 1, 2009, and March 31, 2011. MEASUREMENTS: 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." RESULTS: 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. CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)221-225
Number of pages5
JournalJournal of Hospital Medicine
Volume9
Issue number4
DOIs
StatePublished - 2014

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Venous Thrombosis
Pulmonary Embolism
Incidence
Lower Extremity
Hospitalization
Venous Thromboembolism
International Classification of Diseases
Upper Extremity
Intensive Care Units
Inpatients
Neoplasms

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management
  • Medicine(all)

Cite this

Incidence of hospital-acquired venous thromboembolic codes in medical patients hospitalized in academic medical centers. / Khanna, Raman; Maynard, Gregory; Sadeghi, Banafsheh; Hensley, Laurie; Medvedev, Sofia; Danielsen, Beate; White, Richard H.

In: Journal of Hospital Medicine, Vol. 9, No. 4, 2014, p. 221-225.

Research output: Contribution to journalArticle

Khanna, Raman ; Maynard, Gregory ; Sadeghi, Banafsheh ; Hensley, Laurie ; Medvedev, Sofia ; Danielsen, Beate ; White, Richard H. / Incidence of hospital-acquired venous thromboembolic codes in medical patients hospitalized in academic medical centers. In: Journal of Hospital Medicine. 2014 ; Vol. 9, No. 4. pp. 221-225.
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abstract = "BACKGROUND: 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. OBJECTIVE: Establish the incidence and composition of HA-VTE/superficial venous thrombosis (SVT) coded in a large cohort of medical patients. DESIGN: Retrospective analysis of discharges. SETTING: Eighty-three academic medical centers in UHC (formerly University HealthSystem Consortium). PATIENTS: Patients with medical diagnoses hospitalized >2 days between October 1, 2009, and March 31, 2011. MEASUREMENTS: 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.{"} RESULTS: 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. CONCLUSION: 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.",
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T1 - Incidence of hospital-acquired venous thromboembolic codes in medical patients hospitalized in academic medical centers

AU - Khanna, Raman

AU - Maynard, Gregory

AU - Sadeghi, Banafsheh

AU - Hensley, Laurie

AU - Medvedev, Sofia

AU - Danielsen, Beate

AU - White, Richard H

PY - 2014

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N2 - BACKGROUND: 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. OBJECTIVE: Establish the incidence and composition of HA-VTE/superficial venous thrombosis (SVT) coded in a large cohort of medical patients. DESIGN: Retrospective analysis of discharges. SETTING: Eighty-three academic medical centers in UHC (formerly University HealthSystem Consortium). PATIENTS: Patients with medical diagnoses hospitalized >2 days between October 1, 2009, and March 31, 2011. MEASUREMENTS: 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." RESULTS: 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. CONCLUSION: 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.

AB - BACKGROUND: 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. OBJECTIVE: Establish the incidence and composition of HA-VTE/superficial venous thrombosis (SVT) coded in a large cohort of medical patients. DESIGN: Retrospective analysis of discharges. SETTING: Eighty-three academic medical centers in UHC (formerly University HealthSystem Consortium). PATIENTS: Patients with medical diagnoses hospitalized >2 days between October 1, 2009, and March 31, 2011. MEASUREMENTS: 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." RESULTS: 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. CONCLUSION: 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.

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