title: Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study.
abstract: OBJECTIVE
  Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals.
  
  
  METHODS
  A large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002-2009 in New South Wales, Australia.
  
  
  METHODS
  Patients underwent elective surgery within 2 days of admission, aged between 18 and 90 years, and who were not transferred to another acute care facility; 4 362 624 patients were included.
  
  
  METHODS
  VTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR).
  
  
  RESULTS
  2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the highest and those with the lowest rates were significant (between-hospital variation). Smaller hospitals, accommodated in two peer groups, had the lowest overall VTE rates (IRR=0.56:0.33 to 0.95; IRR=0.37:0.23 to 0.61) and exhibited a greater increase (64% and 237% vs 19%) overtime and greater between-hospital variations compared to larger hospitals (IRR=8.64:6.23 to 11.98; IRR=8.92:5.49 to 14.49 vs IRR=3.70:3.32 to 4.12). Mortality among patients with postoperative VTE was 8% and remained stable overtime. No differences in post-VTE death rates and trends were seen between hospital groups; however, larger hospitals exhibited less between-hospital variations (IRR=1.78:1.30 to 2.44) compared to small hospitals (IRR>23). Hospitals performed differently in prevention versus treatment of postoperative VTE.
  
  
  CONCLUSIONS
  VTE incidence is increasing and there is large variation between-hospital and within-hospital peer groups suggesting a varied compliance with VTE preventative strategies and the potential for targeted interventions and quality improvement opportunities.
authors.affiliation: Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.|Epidemiology, Western Sydney Local Health District, Sydney, New South Wales, Australia.
authors.forename: Hassan
authors.identifier: http://orcid.org/0000-0001-7404-8144
authors.initials: H
authors.lastname: Assareh
authors.affiliation: Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.affiliation: Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Lixin
authors.initials: L
authors.lastname: Ou
authors.affiliation: Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Hollis
authors.affiliation: Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hillman
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital & Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Arthas
authors.initials: A
authors.lastname: Flabouris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000601:surgery; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D009517:New South Wales / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology*; D020246:Venous Thrombosis / Q000453:epidemiology*; D055815:Young Adult
keywords: Patient Safety; Post-operative Complication; Public Hospital; Quality Improvement; Venous Thromboembolism