Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study

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dc.contributor.authorAssareh, H.
dc.contributor.authorChen, J.
dc.contributor.authorOu, L.
dc.contributor.authorHollis, S.
dc.contributor.authorHillman, K.
dc.contributor.authorFlabouris, A.
dc.date.issued2014
dc.description.abstractOBJECTIVES: Despite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals. SETTING: A large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002-2009 in New South Wales, Australia. PARTICIPANTS: Patients underwent elective surgery within 2 days of admission, aged between 18 and 90 years, and who were not transferred to another acute care facility; 4 362 624 patients were included. OUTCOME MEASURES: VTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR). RESULTS: 2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the highest and those with the lowest rates were significant (between-hospital variation). Smaller hospitals, accommodated in two peer groups, had the lowest overall VTE rates (IRR=0.56:0.33 to 0.95; IRR=0.37:0.23 to 0.61) and exhibited a greater increase (64% and 237% vs 19%) overtime and greater between-hospital variations compared to larger hospitals (IRR=8.64:6.23 to 11.98; IRR=8.92:5.49 to 14.49 vs IRR=3.70:3.32 to 4.12). Mortality among patients with postoperative VTE was 8% and remained stable overtime. No differences in post-VTE death rates and trends were seen between hospital groups; however, larger hospitals exhibited less between-hospital variations (IRR=1.78:1.30 to 2.44) compared to small hospitals (IRR>23). Hospitals performed differently in prevention versus treatment of postoperative VTE. CONCLUSIONS: VTE incidence is increasing and there is large variation between-hospital and within-hospital peer groups suggesting a varied compliance with VTE preventative strategies and the potential for targeted interventions and quality improvement opportunities.
dc.description.statementofresponsibilityHassan Assareh, Jack Chen, Lixin Ou, Stephanie J Hollis, Kenneth Hillman, Arthas Flabouris
dc.identifier.citationBMJ Open, 2014; 4(10):e005502-1-e005502-10
dc.identifier.doi10.1136/bmjopen-2014-005502
dc.identifier.issn2044-6055
dc.identifier.issn2044-6055
dc.identifier.orcidFlabouris, A. [0000-0002-1535-9441]
dc.identifier.urihttp://hdl.handle.net/2440/91804
dc.language.isoen
dc.publisherBMJ Publishing Group
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1009916
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1020660
dc.rightsThis is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
dc.source.urihttps://doi.org/10.1136/bmjopen-2014-005502
dc.subjectHumans
dc.subjectNeoplasms
dc.subjectPulmonary Embolism
dc.subjectAortic Aneurysm, Abdominal
dc.subjectVenous Thrombosis
dc.subjectPostoperative Complications
dc.subjectArthroplasty, Replacement
dc.subjectIncidence
dc.subjectRisk Factors
dc.subjectRetrospective Studies
dc.subjectCohort Studies
dc.subjectComorbidity
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectMiddle Aged
dc.subjectHospitals, Public
dc.subjectAustralia
dc.subjectNew South Wales
dc.subjectFemale
dc.subjectMale
dc.subjectHeart Failure
dc.subjectVenous Thromboembolism
dc.subjectYoung Adult
dc.subjectOutcome Assessment, Health Care
dc.titleRate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study
dc.typeJournal article
pubs.publication-statusPublished

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