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Characterizing geographic variation in postoperative venous thromboembolism
Craig S Brown1, Nicholas H Osborne1, Ushapoorna Nuliyalu2
1Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Journal of Vascular Surgery. Venous and Lymphatic Disorders
|April 29, 2023
Summary
Post-surgery venous thromboembolism (VTE) rates vary significantly across U.S. hospitals. Identifying high-risk regions and hospitals can guide targeted quality improvement for VTE prevention.
Area of Science:
- Medical research
- Public health
- Surgical outcomes
Background:
- Venous thromboembolism (VTE) is a significant cause of death and illness following major surgery.
- Despite efforts to improve VTE prevention, the extent of variation in VTE rates across U.S. hospitals and regions is not well understood.
Purpose of the Study:
- To investigate the degree of variation in 90-day VTE rates among Medicare beneficiaries undergoing major surgery across U.S. hospitals and hospital referral regions (HRRs).
Main Methods:
- A retrospective cohort study included over 4 million Medicare beneficiaries from 4,116 U.S. hospitals between 2016 and 2018.
- Calculated 90-day VTE rates, adjusting for patient and hospital factors using multilevel logistic regression.
- Analyzed variations in VTE rates across individual hospitals and HRRs.
Main Results:
- A total of 2.8% of patients (116,450) experienced VTE within 90 days.
- 90-day VTE rates varied by procedure, ranging from 2.5% to 8.4%.
- Significant variation in VTE rates was observed across hospitals (6.6-fold) and HRRs (2.6-fold), with substantial variation in the coefficient of variation (12.1-fold) across HRRs.
Conclusions:
- Significant variation in postoperative VTE rates exists among U.S. hospitals.
- Identifying HRRs with high VTE rates and high inter-hospital variability is crucial for developing targeted quality improvement initiatives.
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