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


METHODS
Retrospective analysis of discharges.


METHODS
Eighty-three academic medical centers in UHC (formerly University HealthSystem Consortium).


METHODS
Patients with medical diagnoses hospitalized >2 days between October 1, 2009, and March 31, 2011.


METHODS
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.


CONCLUSIONS
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.
Department of Medicine, University of California San Francisco, San Francisco, California.
Raman
R
Khanna
Gregory
G
Maynard
Banafsheh
B
Sadeghi
Laurie
L
Hensley
Sofia
S
Medvedev
Beate
B
Danielsen
Richard H
RH
White
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control
D005343:Fibrinolytic Agents