C. N. Holcomb1, A. DeRussy2, J. S. Richman1,2, M. T. Hawn1,2 1University Of Alabama At Birmingham,Gastrointestinal Surgery,Birmingham, AL, USA 2The Center For Surgical, Medical, Acute Care Research And Transitions,Birmingham VA Hospital,Birmingham, AL, USA
Introduction:
Hospital venous thromboembolism (VTE) screening practices, but not adherence to SCIP VTE prophylaxis measures, have been reported to explain variation in hospital VTE rates. We examined the relationship between inpatient VTE screening and post-discharge VTE rates at the hospital level to determine whether more frequent inpatient screening is associated with reduced post-discharge VTE occurrence.
Methods:
We linked national Veterans Affairs (VA) Surgical Quality Improvement Program outcome data to VA administrative data on patients undergoing inpatient surgery from 2005 to 2009 included in the SCIP VTE measurement population. Screening was identified using CPT codes for diagnostic VTE imaging. Relationships for hospital-level screening and VTE rates were assessed with Pearson Correlation Coefficients and post-discharge VTE rate was modeled using multivariable linear regression adjusting for hospital volume, inpatient VTE rate, inpatient screening rate and case mix.
Results:
Of the 25,975 patients at 79 VA facilities, 296 patients (1.4%) experienced a VTE during the index hospitalization and 114 (0.4%) experienced a post-discharge VTE within 30 days of surgery. A positive correlation between inpatient screening and inpatient VTE rates (R=0.33, p=0.003)( Figure A), but no correlation between inpatient screening and neither post-discharge screening (R=0.11, p=0.29) nor post-discharge VTE rates (R=0.03, p=0.76) (Figure B) was observed. In multivariable linear regression modeling of post-discharge hospital VTE rate, only inpatient VTE rate was significant (β=0.13, p=0.05).
Conclusion:
Hospitals with more liberal VTE screening have higher inpatient VTE events, but not decreased post-discharge VTE events. However, hospitals with higher inpatient VTE rates have higher post-discharge VTE rates, suggesting that screening may be influenced by higher observed rates and not surveillance practices alone.
