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Hidden burden of venous thromboembolism after trauma

A national analysis

Rattan, Rishi MD; Parreco, Joshua MD; Eidelson, Sarah A. MD; Gold, Joann; Dharmaraja, Arjuna; Zakrison, Tanya L. MD, MPH; Dante Yeh, D. MD; Ginzburg, Enrique MD; Namias, Nicholas MD

Journal of Trauma and Acute Care Surgery: November 2018 - Volume 85 - Issue 5 - p 899–906
doi: 10.1097/TA.0000000000002039
2018 WTA PODIUM PAPER
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CME

BACKGROUND Trauma patients are at increased risk for venous thromboembolism (VTE). One in four trauma readmissions occur at a different hospital. There are no national studies measuring readmissions to different hospitals with VTE after trauma. Thus, the true national burden in trauma patients readmitted with VTE is unknown and can provide a benchmark to improve quality of care.

METHODS The Nationwide Readmission Database (2010–2014) was queried for patients ≥18 years non-electively admitted for trauma. Patients with VTE or inferior vena cava filter placement on index admission were excluded. Outcomes included 30-day and 1-year readmission to both index and different hospitals with a new diagnosis of VTE. Multivariable logistic regression identified risk factors. Results were weighted for national estimates.

RESULTS Of the 5,151,617 patients admitted for trauma, 1.2% (n = 61,800) were readmitted within 1 year with VTE. Of those, 29.6% (n = 18,296) were readmitted to a different hospital. Risk factors for readmission to a different hospital included index admission to a for-profit hospital (OR 1.33 [1.27–1.40], p < 0.001), skull fracture (OR 1.20 [1.08–1.35], p < 0.001), Medicaid (OR 1.16 [1.06–1.26], p < 0.001), hospitalization >7 days (OR 1.12 [1.07–1.18], p < 0.001), and the lowest quartile of median household income for patient ZIP code (OR 1.13 [1.07–1.19], p < 0.01). The yearly cost of 1-year readmission for VTE was $256.9 million, with $90.4 million (35.2%) as a result of different hospital readmission.

CONCLUSIONS Previously unreported, over one in three patients readmitted with VTE a year after hospitalization for trauma, accounting for over a third of the cost, present to another hospital and are not captured by current metrics. Risk factors are unique. This has significant implications for benchmarking, outcomes, prevention, and policy.

LEVEL OF EVIDENCE Epidemiological study, level II.

From the University of Miami Miller School of Medicine (R.R., J.P., S.A.E., A.D., T.L.Z., D.D.Y., E.G., N.N.), Miami, Florida; and Florida International University School of Medicine (J.G.), Miami, Florida.

Presented at: 48th Annual Meeting of Western Trauma Association, February 28 to March 5, 2018 in Whistler, British Columbia, Canada.

Address for reprints: Rishi Rattan, MD, 1800 NW 10th Ave, T215 (D-40), Miami, FL 33136; email: rrattan@miami.edu.

© 2018 Lippincott Williams & Wilkins, Inc.