Defining the Economic Burden of Perioperative Venous Thromboembolism in Inflammatory Bowel Disease in the United States.

BACKGROUND Patients with IBD are at increased risk of venous thromboembolism. OBJECTIVE This study aims to define the economic burden associated with inpatient venous thromboembolism after surgery for IBD that presently remains undefined. DESIGN This study is a retrospective, cross-sectional analysis using the National Inpatient Sample from 2004 to 2014. SETTING Participating hospitals across the United States were sampled. PATIENTS The International Classification of Diseases, 9th Revision codes were used to identify patients with a primary diagnosis of IBD. INTERVENTIONS Major abdominopelvic bowel surgery was performed. MAIN OUTCOME MEASURES The primary outcome measured was the occurrence of inpatient venous thromboembolism. Univariate and multivariable patient- and hospital-level logistic regression models were used to compare patient characteristics, hospital characteristics, and outcomes between venous thromboembolism and non-venous thromboembolism cohorts. Total average direct costs were then compared between cohorts, and the resulting difference was extrapolated to the national population. RESULTS Of 26,080 patients included, inpatient venous thromboembolism was identified in 581 (2.2%). On multivariable analysis, diagnosis of ulcerative colitis, transfer status, length of preoperative hospitalization, and insurance status were independently associated with inpatient venous thromboembolism. Patients with venous thromboembolism were observed to be associated with an increased median length of stay (17.6 vs 6.7 days; p < 0.001) and higher inpatient mortality (5.0% vs 1.1%; OR 4.7, SE 3.2-7.0; p < 0.001). After adjusting for clinically relevant covariates, the additional cost associated with each inpatient venous thromboembolism was $31,551 (95% CI, $29,136-$33,965). LIMITATIONS Our study is limited by the administrative nature of the National Inpatient Sample database, which limits our ability to evaluate the impact of clinical covariates (eg, use of venous thromboembolism chemoprophylaxis, steroid use, and nutrition status). CONCLUSION Inpatient venous thromboembolism in abdominopelvic surgery for IBD is an infrequent, yet costly, morbid complication. Given the magnitude of patient morbidity and economic burden, venous thromboembolism prevention should be a national quality improvement and research priority. See Video Abstract at http://links.lww.com/DCR/B544. DEFINICIN IMPACTO ECONMICO DE LA TROMBOEMBOLIA VENOSA PERIOPERATORIA EN LA ENFERMEDAD INFLAMATORIA INTESTINAL EN LOS ESTADOS UNIDOS ANTECEDENTES:Pacientes con enfermedad inflamatoria intestinal (EII) tienen un mayor riesgo de tromboembolismo venoso (TEV).OBJETIVO:Definir el impacto economico de TEV hospitalaria despues de la cirugia por EII, que en la actualidad permanece indefinida.DISENO:Un analisis transversal retrospectivo utilizando la Muestra Nacional de Pacientes Internos (NIS) de 2004 a 2014.ENTORNO CLINICO:Hospitales participantes muestreados en los Estados Unidos.PACIENTES:Se utilizaron los codigos de la 9a edicion de la Clasificacion Internacional de Enfermedades (ICD-9) para identificar a los pacientes con diagnostico primario de EII.INTERVENCIONES:Cirugia mayor abdominopelvica intestinal.PRINCIPALES MEDIDAS DE VALORACION:Incidencia de TEV en pacientes hospitalizados, utilizando modelos de regresion logistica univariado y multivariable a nivel de pacientes y hospitales para comparar las caracteristicas de los pacientes, las caracteristicas del hospital y los resultados entre las cohortes de TEV y no TEV. Se compararon los costos directos promedio totales entre cohortes y la diferencia resultante extrapolando a la poblacion nacional.RESULTADOS:De 26080 pacientes incluidos, se identifico TEV hospitalario en 581 (2,2%). En analisis multivariable, el diagnostico de colitis ulcerosa, el estado de transferencia (entre centros hospitalarios), la duracion de la hospitalizacion preoperatoria y el nivel de seguro medico se asociaron de forma independiente con la TEV hospitalaria. Se observo que los pacientes con TEV se asociaron con un aumento de la duracion media de la estancia (17,6 versus a 6,7 dias; p <0,001) y una mayor mortalidad hospitalaria (5,0% versus a 1,1%; OR 4,7, SE 3,2 -7,0; p <0,001). Despues de ajustar las covariables clinicamente relevantes, el costo adicional asociado con cada TEV para pacientes hospitalizados fue de $ 31,551 USD (95% C.I. $ 29,136 - $ 33,965).LIMITACIONES:Estudio limitado por la naturaleza administrativa de la base de datos del NIS, que limita nuestra capacidad para evaluar el impacto de las covariables clinicas (por ejemplo, el uso de quimioprofilaxis de TEV, el uso de esteroides y el estado nutricional).CONCLUSION:TEV hospitalaria en la cirugia abdominopelvica para la EII es una complicacion morbida infrecuente, pero costosa. Debido a la magnitud de la morbilidad el impacto economico, la prevencion del TEV deberia ser una prioridad de investigacion y para mejoria de calidad a nivel nacional. Consulte Video Resumen en http://links.lww.com/DCR/B544.