National Trends in Hospitalizations for Venous Thromboembolism

Abstract

Objective: Prior studies have suggested a relationship between operative time and outcome after major vascular procedures. This study analyzed factors associated with operative time and outcome after carotid endarterectomy (CEA) in the national Vascular Quality Initiative (VQI) registry.Methods: Elective, primary CEAs without high anatomic risk or concomitant procedures from 2012 to 2015 in the VQI were analyzed (N ¼ 26,327, performed by 1188 surgeons from 249 centers). Multivariable analysis was used to identify factors associated with operative time and major adverse events, categorized as either technical (ipsilateral stroke, cranial nerve injury, surgical site infection, reoperation) or cardiac (myocardial infarction, congestive heart failure, dysrhythmia).Results: Median CEA operative time was 109 minutes (interquartile range, 85-136). Factors that increased operative time by at least 5 minutes are shown in Table I. Increasing operative time was associated with increased rates of major adverse events (Table II). Increased cardiac complications were independently associated with increased operative time but not with annual surgeon volume. Increased technical complications were associated with increased operative time, but this effect was mitigated by higher annual surgeon volume.Conclusions: Operative time for elective, primary CEAs varies substantially across the VQI. Operative time is associated with surgeon annual volume in addition to expected procedural factors. Longer operative time increases the risk of cardiac complications and is associated with increased technical complications. In addition to proper patient selection and technical proficiency, attention to operative time is important for improving outcomes after CEA.

Increasing rates of venous thromboembolism among hospitalised patients with inflammatory bowel disease: a nationwide analysis

“…Last, the increasing rates of VTE observed over time appear unique to IBD, as individuals with celiac disease do not have increasing rates of VTE. This, in addition to studies showing stable to slower increases in VTE rates among the general population, further support this notion and decrease the likelihood that our findings are attributable to an overall increased recognition, diagnosis or coding of VTE 14,49 . However, it is still possible, that our findings may in part be the result of an increasing ascertainment of minor VTE events over time.…”

Rate and impact of venous thromboembolism in patients with ST-segment elevation myocardial infarction: Analysis of the Nationwide Inpatient Sample database 2003–2013

“…These results are in agreement with current literature. 27–31 There is a sizeable body of evidence linking heart failure, coagulopathy, malignancy, and paralysis 30,32–36 with VTE occurrence, and indeed these factors were among the independent predictors of VTE in our analysis.…”

Management of venous thromboembolism with non–vitamin K oral anticoagulants: A review for nurse practitioners and pharmacists

“…Common risk factors include hospitalization for surgery or acute illness, trauma or fracture, prolonged immobility, active cancer, obesity, and increasing age (Heit, Spencer, & White, 2016).The annual incidence of VTE events in the United States (US) ranges from 300,000 to 600,000 (Mozaffarian et al, 2016) and is associated with significant morbidity and mortality (Spyropoulos, Preblick, Kwong, Lingohr-Smith, & Lin, 2015). VTE and its complications are an economic burden, costing the US health care system $7-10 billion dollars per year (Brahmandam, Abougergi, & Ochoa Chaar, 2017). Standard therapy for treating VTE includes parenteral anticoagulation with heparin overlapping with an oral vitamin K antagonist (VKA) such as warfarin, followed by a VKA alone.…”