Incidences and variations of hospital acquired venous thromboembolism in Australian hospitals: a population-based study.

Hassan Assareh,Ken Hillman,Jack Chen,Lixin Ou,Arthas Flabouris

doi:10.1186/s12913-016-1766-y

Abstract

BackgroundData on hospital-acquired venous thromboembolism (HA-VTE) incidence, case fatality rate and variation amongst patient groups and health providers is lacking. We aim to explore HA-VTE incidences, associated mortality, trends and variations across all acute hospitals in New South Wales (NSW)-Australia.MethodsA population-based study using all admitted patients (aged 18–90 with a length of stay of at least two days and not transferred to another acute care facility) in 104 NSW acute public and private hospitals during 2002–2009. Poisson mixed models were used to derive adjusted rate ratios (IRR) in presence of patient and hospital characteristics.ResultsAmongst, 3,331,677 patients, the incidence of HA-VTE was 11.45 per 1000 patients and one in ten who developed HA-VTE died in hospital. HA-VTE incidence, initially rose, but subsequently declined, whereas case fatality rate consistently declined by 22 % over the study period. Surgical patients were 128 % (IRR = 2.28, 95 % CI: 2.19–2.38) more likely to develop HA-VTE, but had similar case fatality rates compared to medical patients. Private hospitals, in comparison to public hospitals had a higher incidence of HA-VTE (IRR = 1.76; 95 % CI: 1.42–2.18) for medical patients. However, they had a similar incidence (IRR = 0.91; 95 % CI: 0.75–1.11), but a lower mortality (IRR = 0.59; 95 % CI: 0.47–0.75) amongst surgical patients. Smaller public hospitals had a lower HA-VTE incidence rate compared to larger hospitals (IRR < 0.68) but a higher case fatality rate (IRR > 1.71). Hospitals with a lower reported HA-VTE incidence tended to have a higher HA-VTE case fatality rate.ConclusionDespite the decline in HA-VTE incidence and case fatality, there were large variations in incidents between medical and surgical patients, public and private hospitals, and different hospital groups. The causes of such differences warrant further investigation and may provide potential for targeted interventions and quality improvement initiatives.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1766-y) contains supplementary material, which is available to authorized users.

Highlights

Data on hospital-acquired venous thromboembolism (HA-Venous thromboembolism (VTE)) incidence, case fatality rate and variation amongst patient groups and health providers is lacking
Venous thromboembolism (VTE), comprising both deep venous thrombosis (DVT) and pulmonary embolism (PE) are potentially preventable and treatable medical conditions that can contribute to patient morbidity and
The significant negative correlations between individual hospital hospital-acquired venous thromboembolism (HA-VTE) rates and HA-VTEs case fatality rates for private hospital peer groups implied that hospitals with the highest HA-VTE rate tended to have a lower rate of subsequent death. There were no such associations within other public hospitals peer groups. In this large cohort study of all New South Wales (NSW) acute hospitals during 2002–2009, we found that over 1 in 100 patients developed HA-VTE

Summary

Introduction

Data on hospital-acquired venous thromboembolism (HA-VTE) incidence, case fatality rate and variation amongst patient groups and health providers is lacking. We aim to explore HA-VTE incidences, associated mortality, trends and variations across all acute hospitals in New South Wales (NSW)-Australia. Substantial variation in trends and rates amongst similar hospitals [14], after adjustment for case mix and surgery types [18, 19], may reflect variation in compliance with VTE prevention strategies and the potential for further improvement [20]. We adopted a validated measure of HA-VTE to explore trends in the rates of HA-VTE, and associated mortality amongst admitted patients to all acute public and private hospitals in New South Wales (NSW), Australia between 2002 and 2009. Patients’ and hospitals’ contributing factors to the HA-VTE trends and variations were examined

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