In-hospital risk of venous thromboembolism and bleeding and associated costs for patients undergoing total hip or knee arthroplasty

Abstract

Objective:

Benefits of anti-coagulation for venous thromboembolism (VTE) prevention in total hip and knee arthroplasty (THA/TKA) may be offset by increased risk of bleeding. The aim was to assess in-hospital risk of VTE and bleeding after THA/TKA and quantify any increased costs.

Methods:

Healthcare claims from the Premier Perspective^TM Comparative Hospital Database (January 2000–September 2008) were selected for subjects ≥18 years with ≥1 diagnosis code for THA/TKA. VTE was defined as ≥1 code for deep vein thrombosis or pulmonary embolism. Bleeding was classified as major/non-major. Incremental in-hospital costs associated with VTE and bleeding were calculated as cost differences between inpatients with VTE or bleeding matched 1:1 with inpatients without VTE or bleeding.

Results:

A total of 820,197 inpatient stays were identified: 8042 had a VTE event and 7401 a bleeding event (2740 major bleeding). The risks of VTE, any bleeding, and major bleeding were 0.98, 0.90, and 0.33/100 inpatient stays, respectively. Mean incremental in-hospital costs per inpatient were $2663 for VTE, $2028 for bleeding, and $3198 for major bleeding.

Limitations:

These included possible inaccuracies or omissions in procedures, diagnoses, or costs of claims data; no information on the amount of blood transfused or decreases in the hemoglobin level to evaluate bleeding event severity; and potential biases due to the observational design of the study.

Conclusions:

In-hospital risk and incremental all-cause costs with THA/TKA were higher for VTE than for bleeding. Despite higher costs, major bleeding occurred less frequently than VTE, suggesting a favorable benefit/risk profile for VTE prophylaxis in THA/TKA.

Keywords::

• Total hip arthroplasty
• Total knee arthroplasty
• Venous thromboembolism
• Bleeding
• Hospitalization
• Risk
• Costs

Transparency

Declaration of funding

This research was funded by Janssen Scientific Affairs, LLC, Raritan, NJ, USA.

Declaration of financial relationships

Five of the authors (Vekeman, Laliberté, Duh, Dea, and Lefebvre) are employees of Analysis Group, Inc., a consulting company that has received research grants from Janssen Scientific Affairs, LLC; and four of the authors (LaMori, Bookhart, Schein, and Olson) are employees of Janssen Scientific Affairs, LLC. Three of the authors own stock in Johnson & Johnson (Bookhart, LaMori, Olson). E. Nutescu received research grants from Janssen Scientific Affairs, LLC, Raritan, NJ, USA.

Acknowledgments

The authors would like to acknowledge Isabelle Leach, MBChB, for editorial assistance in the preparation of this manuscript with funding from Janssen Scientific Affairs, LLC.

Parts of this work were presented as posters at the National Association of Orthopaedic Nurses (NAON) 30th Annual Congress, May 15–19, 2010, Seattle, Washington, and the Academy of Managed Care Pharmacy (AMCP) 22nd Annual Meeting and Showcase, April 6–10, San Diego, CA.