Resource utilization and charges of patients with and without diagnosed venous thromboembolism during primary hospitalization and after elective inpatient surgery: a retrospective study

Abstract

Aims: To assess incremental charges of patients experiencing venous thromboembolisms (VTE) across various types of elective inpatient surgical procedures with administration of general anesthesia in the US.

Methods: The authors performed a retrospective study utilizing data from a nationwide hospital operational records database from July 2014 through June 2015 to compare a group of inpatients experiencing a VTE event post-operatively to a propensity score matched group of inpatients who did not experience a VTE. Patients included in the analysis had a hospital admission for an elective inpatient surgical procedure with the use of general anesthesia. Procedures of the heart, brain, lungs, and obstetrical procedures were excluded, as these procedures often require a scheduled ICU stay post-operatively. Outcomes examined included VTE events during hospitalization, length of stay, unscheduled ICU transfers, number of days spent in the ICU if transferred, 3- and 30-day re-admissions, and total hospital charges incurred.

Results: The study included 17,727 patients undergoing elective inpatient surgical procedures. Of these, 36 patients who experienced a VTE event were matched to 108 patients who did not. VTE events occurred in 0.2% of the study population, with most events occurring for patients undergoing total knee replacement. VTE patients had a mean total hospital charge of $60,814 vs $48,325 for non-VTE patients, resulting in a mean incremental charge of $11,979 (p < .05). Compared to non-VTE patients, VTE patients had longer length of stay (5.9 days vs 3.7 days, p < .001), experienced a higher rate of 3-day re-admissions (3 vs 0 patients) and 30-day re-admissions (7 vs 2 patients).

Conclusions: Patients undergoing elective inpatient surgical procedures with general anesthesia who had a VTE event during their primary hospitalization had a significantly longer length of stay and significantly higher total hospital charges than comparable patients without a VTE event.

Keywords:

• Venous thromboembolism
• VTE
• resource utilization
• healthcare resource utilization
• total hospital charge
• charge
• anesthesia
• retrospective

Transparency

Declaration of funding

This study and manuscript was supported by Millennium Health. The design, study conduct, and financial support for the study were provided by Millennium Health. Millennium Health participated in the study design, research, interpretation of data, writing, review, and approval of the manuscript.

Declaration of financial/other relationships

VD and MDK were/are salaried employees of IQVIA, who received consultancy fees from Millennium Health. FC and RBJ are employees of Millennium Health, and may own Millennium Health stock or stock options. AS has received post-doctoral fellowship funding from UCSD. RG and AM are employees of UC San Diego Health Systems and received consultancy fees from Millennium Health for providing clinical expertise for the design of this study. AM is also receiving a mentored training grant from the International Anesthesia Research Society. The authors have no other relevant affiliations or financial involvement with any organization or entity with financial interest in, or financial conflict with, the subject matter or materials discussed in the manuscript, apart from those disclosed. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We would like to acknowledge Sanyi Zhao, MS, for her input on the statistical analysis plan for this study.