High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

Abstract

BackgroundVenous thromboembolism (VTE) is the third leading cause of vascular disease and accounts for $10 billion in annual US healthcare costs. The nationwide burden of 30‐day readmissions after such events has not been comprehensively assessed.Methods and ResultsWe analyzed adults ≥18 years of age with hospitalizations associated with acute VTE between January 1, 2010, and December 31, 2014, in the Nationwide Readmissions Database. International Classification of Disease, Ninth Revision, Clinical Modification (ICD‐9‐ CM) codes were used to identify hospitalizations associated with acute pulmonary embolism or deep vein thrombosis. The primary outcome was the rate of unplanned 30‐day readmission. Hierarchical logistic regression was used to calculate hospital‐specific 30‐day risk‐standardized readmission rates, a marker of healthcare quality. Among 1 176 335 hospitalizations with acute VTE, in‐hospital death occurred in 6.2%. VTE was associated with malignancy in 19.7%, recent surgery in 19.3%, recent trauma in 4.6%, hypercoagulability in 3.3%, and pregnancy in 1.0%. Among survivors to discharge, the 30‐day readmission rate was 17.5%, with no significant difference in rates across study years (17.4%–17.7%; P=0.10 for trend). Major predictors of readmission were malignancy (relative risk, 1.49, 95% confidence interval 1.47‐1.50), Medicaid insurance (relative risk, 1.48, 95% confidence interval 1.46‐1.50), and nonelective index admission (relative risk, 1.31, 95% confidence interval 1.29‐1.33). Top causes of readmission included sepsis (9.6%) and procedural complications (8.1%). Median rehospitalization costs were $9781.7 (interquartile range, $5430.7–$18 784.1), and 8.1% died during readmission. The interquartile range in risk‐standardized readmission rates was 16.6% to 18.3%, suggesting modest interhospital heterogeneity in readmission risk.ConclusionsNearly 1 in 5 patients with acute VTE were readmitted within 30 days. Predictors and causes of readmission were primarily related to patient characteristics and complications from comorbid conditions, whereas healthcare quality had a moderate impact on readmission risk.

Reducing Hospitalizations and Emergency Department Visits in Patients With Venous Thromboembolism Using a Multicomponent Care Transition Intervention

“…Secemsky et al found that 17.5% of patients had readmission to hospital within 30 days of VTE hospitalization. 1 They did not measure utilization of ED, calculate an incidence rate, or follow up patients out to 90 days limiting comparison with our study. We did not have sufficient sample size to examine the distinct effect of the intervention in low health literacy patients.…”

The effect of catheter‐directed thrombolytic use on readmission rates and in‐hospital outcomes among cancer patients with venous thromboembolism in the United States

“…We created a new cohort using discharge‐level data from all hospitalizations from State Inpatient Databases of geographically dispersed participating states (18‐27 states) 5 . During cohort creation using NRD, we utilized the ICD‐9‐CM codes to identify all hospitalized adults, at least 18 years old, who had a primary diagnosis (DX1) of VTE (PE or DVT) (453.2, 451.1, 451.8, 453.4, 453.8, 453.5, 453.7, 415.1) for the year 2013 to 2014 5 . All cancer patients were identified using ICD‐9, CCS codes or comorbidities in NRD 5 .…”

“…5 All cancer patients were identified using ICD-9, CCS codes or comorbidities in NRD. 5 All patients with metastatic disease (CM_METS) were excluded from the cancer cohort. The outcome studied was CDL therapy (ICD-9 88.60, 88.66, 88.69, 39.90, 88.40, 88.43, 88.44, or 88.49 in combination with 99.10).…”

Frequency of hospital readmissions for venous thromboembolism and associated hospital costs and length of stay among acute medically ill patients in the US

“…Another recently conducted study points out the significant cost burden associated with readmission after discharge from an acute VTE hospitalization, especially among patients with serious comorbidities 14 . Using data from the Nationwide Readmission Database, Secemsky et al 14 identified 1,176,335 hospitalizations for acute VTE between January 1, 2010 and December 31, 2014; of the patients hospitalized for acute VTE, 6.2% died during hospitalization; of those who survived, 17.5% had another hospitalization (for any cause) within 30 days; of those with a readmission, 8.1% died.…”