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Hospital VTE surveillance fails to decrease rates after discharge
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Inpatient surveillance for venous thromboembolism after surgery was associated with higher rates for inpatient venous thromboembolism but did not reduce the rates postdischarge, according to results of a retrospective analysis.
Further, the correlation between high inpatient and postdischarge VTE rates within a hospital suggest that surveillance may be influenced by higher observed rates and not surveillance practices alone, the researchers wrote.
Despite the enactment of Surgical Care Improvement Program (SCIP) prophylaxis measures in 2006, hospital VTE rates still vary, according to study background. Further, surveillance bias may affect data, as researchers have shown hospital VTE rates are strongly associated with surveillance practices and not adherence to SCIP VTE measures.
Carla N. Holcomb
Carla N. Holcomb, MD, of the department of surgery at the University of Alabama at Birmingham, and colleagues sought to examine the relationship between inpatient surveillance for VTE and the rate of VTE after being discharged from the hospital. The goal was to determine whether a higher frequency of surveillance was associated with a reduced occurrence of VTE after discharge.
The analysis included a national cohort of 25,975 patients who had inpatient surgery between 2005 and 2009 at one of 79 Veterans Affairs facilities.
Overall, 1.4% of the population experienced a VTE during hospitalization and 0.4% experienced VTE after discharge but within 30 days of the surgical procedure.
The median hospital stay for patients who had a positive surveillance test was 11 days, and patients who had a negative test result had a medial hospital stay of 9 days.
Although there was a positive relationship between surveillance and VTE rates for inpatients (P = .003), researchers noted there were no significant associations between inpatient surveillance and surveillance after discharge or the rate of VTE after discharge.
Results of an adjusted regression model indicated the inpatient VTE rate was only associated with the VTE postdischarge rate (beta = 0.13, P = .05).
The researchers recognized some study limitations, including that the population consisted mostly of older men, which may limit the ability to generalize the data to other populations. The analysis also only assessed VTE prevention as measured by SCIP, meaning other institutional VTE prevention practices could skew the data.
Although the study period ended in 2009, researchers noted SCIP adherence approached 100% by that time and, therefore, changes in VTE outcomes since then are unlikely.
“Postdischarge VTE rates in the 30 days after surgery are not decreased by higher inpatient surveillance rates but are associated with higher inpatient VTE rates,” Holcomb and colleagues concluded. “Thus, patient risk factors and case mix likely contribute to hospital VTE rates, and surveillance bias may reflect the underlying at-risk population. Using its current definition, we find that SCIP-VTE adherence is an inadequate assessment of hospital quality because it is not associated with VTE outcomes. Further research is needed to determine whether refined VTE prophylaxis measures or outcome assessment can be reliable measures of surgical quality.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Harry S. Jacob, MD, FRCPath(Hon)
These results can also be interpreted as demonstrating the need for continued post-discharge oral anticoagulation for many surgery patients — at least until they are fully mobile. I disagree that the studies “call into question … the measurement of SCIP-VTE adherence.”
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