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ANTICOAGULATION

Burden of Deep Vein Thrombosis in the Outpatient Setting Following Major Orthopedic Surgery

Clinical Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL

Andrew F Shorr, MD

Associate Director, Pulmonary and Critical Care, Washington Hospital Center; Associate Professor of Medicine, Georgetown University, Washington, DC

Eileen Farrelly, MPH

Associate Director, Xcenda, Palm Harbor, FL

Ruslan Horblyuk, MBA

Health Outcomes Scientist, Cardiovascular/Metabolic/Oncology, GlaxoSmithKline, Philadelphia, PA

Laura E Happe, PharmD

Associate Director, Xcenda

Meg Franklin, PhD

Assistant Director, Xcenda

Reprints: Dr. Happe, Xcenda, 4114 Woodlands Parkway, Ste. 500, Palm Harbor, FL 34685, fax 727/771-4144, laura.happe{at}xcenda.com

BACKGROUND: Venous thromboembolism (VTE) is a known complication of major orthopedic surgery (MOS) with important clinical and economic consequences. Recently published orthopedic guidelines have focused on prevention of pulmonary embolism as a primary outcome, but deep vein thrombosis (DVT) occurrence should not be readily dismissed.

OBJECTIVE: To describe the burden of DVT following hospital discharge for MOS by assessing the impact of DVT on costs and resource utilization from the third-party payer perspective.

METHODS: Retrospective analysis used outpatient medical and pharmacy data from the PharMetrics Patient-Centric Database (January 1, 2002–March 31, 2006). Patients 18 years of age or older with a record of MOS were eligible for inclusion. Included patients were stratified based on the presence of a DVT during the first month after hospital discharge. Characteristics of the samples were described. The impact of DVT on total 6-month costs and resource utilization (readmissions, outpatient, emergency department visits) was assessed through statistical models.

RESULTS: Of the 32,899 patients in the analysis, 1221 (3.71%) had a record of DVT during the first month following discharge for MOS. Compared with patients who did not develop DVT, patients who developed DVT postdischarge were slightly older (56.5 vs 55.8 y; p = 0.0127), had a higher occurrence of prior VTE (26.2% vs 3.4%; p < 0.0001), and had undergone recent surgical procedures other than MOS (73.0% vs 69.6%; p = 0.0116). After controlling for potential confounders, DVT was associated with a 22% and 74% increase in the average number of expected outpatient and emergency department visits, respectively, during the 6-month postdischarge period but did not significantly impact the number of readmissions. Furthermore, total 6-month costs were significantly higher for patients who developed DVT, with an incremental increase of over $2000.

CONCLUSIONS: The burden of DVT following hospital discharge for MOS is substantial. Specifically, DVT increases total costs and outpatient and emergency department visits.

Key Words: costs, deep vein thrombosis, fondaparinux, low-molecular-weight heparin, orthopedic surgery, outpatient prophylaxis, pulmonary embolism, warfarin

Published Online, July 8, 2008. www.theannals.com, DOI 10.1345/aph.1L135