Hidden burden of venous thromboembolism after trauma: A national analysis
| Autor: | D. Dante Yeh, Arjuna Dharmaraja, Tanya L. Zakrison, Enrique Ginzburg, Nicholas Namias, Rishi Rattan, Sarah A. Eidelson, Joshua Parreco, Joann Gold |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent MEDLINE Inferior vena cava filter Critical Care and Intensive Care Medicine Logistic regression Patient Readmission Young Adult 03 medical and health sciences 0302 clinical medicine Risk Factors Poverty Areas Epidemiology medicine Humans cardiovascular diseases 030212 general & internal medicine Young adult Aged Skull Fractures Medicaid business.industry 030208 emergency & critical care medicine Health Care Costs Venous Thromboembolism Evidence-based medicine Length of Stay Middle Aged Hospitals Proprietary Hospitals United States Quartile Emergency medicine Wounds and Injuries Female Surgery business |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 85:899-906 |
| ISSN: | 2163-0763 2163-0755 |
| Popis: | Trauma patients are at increased risk for venous thromboembolism (VTE). One in four trauma readmissions occur at a different hospital. There are no national studies measuring readmissions to different hospitals with VTE after trauma. Thus, the true national burden in trauma patients readmitted with VTE is unknown and can provide a benchmark to improve quality of care.The Nationwide Readmission Database (2010-2014) was queried for patients ≥18 years non-electively admitted for trauma. Patients with VTE or inferior vena cava filter placement on index admission were excluded. Outcomes included 30-day and 1-year readmission to both index and different hospitals with a new diagnosis of VTE. Multivariable logistic regression identified risk factors. Results were weighted for national estimates.Of the 5,151,617 patients admitted for trauma, 1.2% (n = 61,800) were readmitted within 1 year with VTE. Of those, 29.6% (n = 18,296) were readmitted to a different hospital. Risk factors for readmission to a different hospital included index admission to a for-profit hospital (OR 1.33 [1.27-1.40], p0.001), skull fracture (OR 1.20 [1.08-1.35], p0.001), Medicaid (OR 1.16 [1.06-1.26], p0.001), hospitalization7 days (OR 1.12 [1.07-1.18], p0.001), and the lowest quartile of median household income for patient ZIP code (OR 1.13 [1.07-1.19], p0.01). The yearly cost of 1-year readmission for VTE was $256.9 million, with $90.4 million (35.2%) as a result of different hospital readmission.Previously unreported, over one in three patients readmitted with VTE a year after hospitalization for trauma, accounting for over a third of the cost, present to another hospital and are not captured by current metrics. Risk factors are unique. This has significant implications for benchmarking, outcomes, prevention, and policy.Epidemiological study, level II. |
| Databáze: | OpenAIRE |
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