title: In-hospital risk of venous thromboembolism and bleeding and associated costs for patients undergoing total hip or knee arthroplasty.
abstract: OBJECTIVE
  Benefits of anti-coagulation for venous thromboembolism (VTE) prevention in total hip and knee arthroplasty (THA/TKA) may be offset by increased risk of bleeding. The aim was to assess in-hospital risk of VTE and bleeding after THA/TKA and quantify any increased costs.
  
  
  METHODS
  Healthcare claims from the Premier Perspective(TM) Comparative Hospital Database (January 2000-September 2008) were selected for subjects ≥ 18 years with ≥ 1 diagnosis code for THA/TKA. VTE was defined as ≥ 1 code for deep vein thrombosis or pulmonary embolism. Bleeding was classified as major/non-major. Incremental in-hospital costs associated with VTE and bleeding were calculated as cost differences between inpatients with VTE or bleeding matched 1:1 with inpatients without VTE or bleeding.
  
  
  RESULTS
  A total of 820,197 inpatient stays were identified: 8042 had a VTE event and 7401 a bleeding event (2740 major bleeding). The risks of VTE, any bleeding, and major bleeding were 0.98, 0.90, and 0.33/100 inpatient stays, respectively. Mean incremental in-hospital costs per inpatient were $2663 for VTE, $2028 for bleeding, and $3198 for major bleeding.
  
  
  CONCLUSIONS
  These included possible inaccuracies or omissions in procedures, diagnoses, or costs of claims data; no information on the amount of blood transfused or decreases in the hemoglobin level to evaluate bleeding event severity; and potential biases due to the observational design of the study.
  
  
  CONCLUSIONS
  In-hospital risk and incremental all-cause costs with THA/TKA were higher for VTE than for bleeding. Despite higher costs, major bleeding occurred less frequently than VTE, suggesting a favorable benefit/risk profile for VTE prophylaxis in THA/TKA.
authors.affiliation: Groupe d’analyse, Ltée, Montréal, Québec, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Vekeman
authors.forename: J C
authors.initials: JC
authors.lastname: LaMori
authors.forename: F
authors.initials: F
authors.lastname: Laliberté
authors.forename: E
authors.initials: E
authors.lastname: Nutescu
authors.forename: M S
authors.initials: MS
authors.lastname: Duh
authors.forename: B K
authors.initials: BK
authors.lastname: Bookhart
authors.forename: J
authors.initials: J
authors.lastname: Schein
authors.forename: K
authors.initials: K
authors.lastname: Dea
authors.forename: W H
authors.initials: WH
authors.lastname: Olson
authors.forename: P
authors.initials: P
authors.lastname: Lefebvre
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D019992:Databases as Topic; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000191:economics / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D014481:United States; D054556:Venous Thromboembolism / Q000191:economics / Q000209:etiology*