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Post-discharge VTE events should be considered in hospital rankings
When comparing hospitals based on postoperative venous thromboembolism rates, rankings are significantly altered when both pre- and post-discharge events within 30 days of knee or hip arthroplasty are taken into account vs. rankings that only consider pre-discharge events.
Researchers evaluated 23,924 patients who underwent partial or total hip or knee arthroplasty at 95 hospitals from the American College of Surgeons National Surgical Quality Improvement Program database between 2008 and 2010. Metrics analyzed included deep venous thrombosis (DVT), pulmonary embolism (PE), and pre-discharge, post-discharge and 30-day postoperative rates of venous thromboembolism (VTE). The researchers compared risk-adjusted hospital rankings based on only pre-discharge events and those based on both pre-discharge events as well as those within 30 days of surgery.
The VTE rate in patients who underwent hip arthroplasty was 0.9%, of which 57.9% occurred post-discharge, and 1.9% in those who underwent knee arthroplasty, of which 38.3% occurred post-discharge.
Overall, there were 366 instances of VTE, which were broken down into 250 instances of DVT (0.6% for hip arthroplasty cohort; 1.3% for knee arthroplasty cohort) and 145 instances of PE (0.3% for hip arthroplasty cohort; 0.8% for knee arthroplasty cohort). VTE occurred at a median of 11 and 3 days for hip and knee arthroplasty, respectively. In both cohorts, the median duration of stay was three days.
In VTE rate-based hospital rankings, the inclusion of post-discharge events was found to influence hospital outlier status designation with a median change in quality ranking of seven, according to the researchers.
Disclosure: The authors have no relevant financial disclosures.