Details:

Alternative Title:
Thromb Res
Personal Author:
Nelson, Richard E. ; Grosse, Scott D. ; Waitzman, Norman J. ; Lin, Junji ; DuVall, Scott L. ; ... More +
Nelson, Richard E. ; Grosse, Scott D. ; Waitzman, Norman J. ; Lin, Junji ; DuVall, Scott L. ; Patterson, Olga ; Tsai, James ; Reyes, Nimia Less -
Description:
Background

There are limitations to using administrative data to identify postoperative venous thromboembolism (VTE). We used a novel approach to quantify postoperative VTE events among Department of Veterans Affairs (VA) surgical patients during 2005–2010.

Methods

We used VA administrative data to exclude patients with VTE during 12 months prior to surgery. We identified probable postoperative VTE events within 30 and 90 days post-surgery in three settings: 1) pre-discharge inpatient, using a VTE diagnosis code and a pharmacy record for anticoagulation; 2) post-discharge inpatient, using a VTE diagnosis code followed by a pharmacy record for anticoagulation within 7 days; and 3) outpatient, using a VTE diagnosis code and either anticoagulation or a therapeutic procedure code with natural language processing (NLP) to confirm acute VTE in clinical notes.

Results

Among 468,515 surgeries without prior VTE, probable VTEs were documented within 30 and 90 days in 3,931 (0.8%) and 5,904 (1.3%), respectively. Of probable VTEs within 30 or 90 days post-surgery, 47.8% and 62.9%, respectively, were diagnosed post-discharge. Among post-discharge VTE diagnoses, 86% resulted in a VA hospital readmission. Fewer than 25% of outpatient records with both VTE diagnoses and anticoagulation prescriptions were confirmed by NLP as acute VTE events.

Conclusion

More than half of postoperative VTE events were diagnosed post-discharge; analyses of surgical discharge records are inadequate to identify postoperative VTE. The NLP results demonstrate that the combination of VTE diagnoses and anticoagulation prescriptions in outpatient administrative records cannot be used to validly identify postoperative VTE events.


Subject:
[+]
Adult
Aged
Aged, 80 And Over
Article
Cohort Studies
Female
History, 21st Century
Hospitals
Hospitals, Veterans
Humans
Male
Middle Aged
Postoperative Period
Public Health Surveillance
Retrospective Studies
Statistics As Topic
Surgery
Venous Thromboembolism

Source:
Thromb Res. 2015; 135(4):636-642.
Pubmed ID:
25666908
Pubmed Central ID:
PMC4453876
Document Type:
Journal Article
Funding:
CC999999/Intramural CDC HHS/United States ; KM1 CA156723/CA/NCI NIH HHS/United States ; KM1CA156723/CA/NCI NIH HHS/United States
CC999999/Intramural CDC HHS/United States ; KM1 CA156723/CA/NCI NIH HHS/United States ; KM1CA156723/CA/NCI NIH HHS/United States Less -
Place as Subject:
United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:9b438af7ea4035acf941d6025fb38a5ecd07c892b7d38e2d8508250bfd1226eb
File Type:

Supporting Files

• 	NIHMS693260-supplement-Appendix_A.pdf	pdf
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  	nihms693260f1.gif	gif
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