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Venous Thromboembolism as Predictor of Acute Care Hospital Transfer and Inpatient Rehabilitation Length of Stay

Pinto, Shanti M. MD; Galang, Gary MD

American Journal of Physical Medicine & Rehabilitation: June 2017 - Volume 96 - Issue 6 - p 367–373
doi: 10.1097/PHM.0000000000000643
Original Research Articles CME Article . 2017 Series . Number 7

Objective: The aim of this study was to investigate the impact of venous thromboembolism (VTE) on rate of acute care hospital transfer, inpatient rehabilitation (IPR) length of stay (LOS), and functional outcomes.

Design: This was a retrospective cohort study of 2312 consecutive patient discharges from a single IPR facility over an 18-month period.

Results: When age, sex, reason for admission, and admission Functional Independence Measure (FIM) scores were controlled for, those with VTE had nearly 2 times greater odds for transfer to acute care hospital than did those without a diagnosis of VTE. Inpatient rehabilitation LOS was 4.700 days (95% confidence interval [CI], 2.956–6.445 days) longer for those with a diagnosis of VTE prior to IPR admission and 2.287 days (95% CI, 1.026–3.547 days) longer for those with a diagnosis of VTE during IPR admission compared with those without a diagnosis of VTE. There was no difference in FIM change based on VTE diagnosis. Venous thromboembolism diagnosis during IPR was associated with a significant decrease in FIM efficiency (−0.358; 95% CI, −0.654 to −0.062) if diagnosed during IPR admission, but there was no difference in FIM efficiency if VTE was diagnosed prior to IPR.

Conclusions: Patients with a diagnosis of VTE were more likely to be transferred to the acute care hospital and have longer IPR LOS independent of admission FIM scores. It is important to prevent development of VTE.

To Claim CME Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives: Upon completion of this article, the reader should be able to: (1) understand the association of venous thromboembolism (VTE) diagnosis with acute hospital transfer and inpatient rehabilitation length of stay; (2) identify reasons for acute hospital transfer in patients diagnosed with VTE; and (3) understand the relationship between VTE diagnosis and functional outcomes during inpatient rehabilitation.

Level: Advanced

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

All correspondence and requests for reprints should be addressed to: Gary Galang, MD, UPMC Rehabilitation Institute, UPMC Mercy Hospital, 1400 Locust St., Pittsburgh, PA 15219.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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