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Vice-President, Policy Analysis Inc., Brookline, MA
Senior Analyst, Policy Analysis Inc.
Senior Analyst, Policy Analysis Inc.
Senior Consultant, Policy Analysis Inc.
Senior Analyst, Policy Analysis Inc.
Medical Director, Policy Analysis Inc.
Reprints: Gerry Oster PhD, Policy Analysis Inc., Four Davis Ct., Brookline, MA 02445-7629, fax 617/232-1155, goster{at}pai2.com
BACKGROUND: Venous thromboembolism (VTE) is a frequent and potentially costly complication of major orthopedic surgery.
OBJECTIVE: To estimate the economic consequences of VTE following major orthopedic surgery.
METHODS: Using a large healthcare claims database, we
identified all patients who underwent total hip replacement, major knee
surgery, or hip fracture repair from January 1993 to December 1998. Patients
with clinical VTE (cases) were identified based on a diagnosis of deep vein
thrombosis or pulmonary embolism within 90 days of surgery (index admission)
and 
1 prescription for warfarin or unfractionated heparin within 30 days
of the date of initial VTE diagnosis. Each case was matched (using age and
procedure type) to 2 randomly selected patients who did not have any claims
for clinical VTE (matched controls). Utilization and billed charges were then
examined over a 90-day period following admission. Cases were stratified based
on whether VTE was first noted during the index admission or thereafter.
RESULTS: A total of 11 960 patients were identified who underwent total hip replacement, major knee surgery, or hip fracture repair (n = 3171, 3955, 4834, respectively). Over a 90-day period, 259 patients (2.2%) developed clinical VTE. Most cases (61.8%) occurred after hospital discharge. For patients with in-hospital VTE, mean length of stay for the index admission was 4.5 days longer than that of matched controls (11.1 vs 6.6); by day 90, there was a 5.4-day difference in total hospital days. Mean billed charges for the index admission were $17 552 higher ($52 037 vs $34 485); the difference rose to $18 834 by day 90 ($54 480 vs $35 646). For patients who developed clinical VTE following hospital discharge, there was a 3.4-day difference in total hospital days at day 90 (10.2 vs 6.8) as a result of readmissions for VTE; mean total billed charges at day 90 were $5765 higher ($41 411 vs $35 646).
CONCLUSIONS: Among patients who have undergone major orthopedic surgery, the economic consequences of VTE are substantial, regardless of the setting in which it occurs.
Key Words: cost analysis, orthopedics, thrombophlebitis
Published Online, January 12, 2004. www.theannals.com, DOI 10.1345/aph.1C518
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