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The effect of deep venous thrombosis on short-term outcomes and cost of care after head and neck cancer surgery.

Abstract

OBJECTIVES/HYPOTHESIS

The Centers for Medicare and Medicaid Services has targeted deep venous thrombosis (DVT) and pulmonary embolus (PE) as preventable "never events" and has discontinued reimbursement for these conditions following selected orthopedic procedures. We sought to determine the relationship between DVT/PE and in-hospital mortality, postoperative complications, length of stay, and costs in head and neck cancer (HNCA) surgery.

STUDY DESIGN

Retrospective cross-sectional study.

METHODS

Discharge data from the Nationwide Inpatient Sample for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2003 to 2008 were analyzed using cross-tabulations and multivariate regression modeling.

RESULTS

DVT/PE was diagnosed in 1,860 cases (2%) and was significantly associated with major surgical procedures (odds ratio [OR], 1.4; P = .048) and advanced comorbidity (OR, 1.7; P = .034). After controlling for all other variables, no association was found between a diagnosis of DVT/PE and obesity, weight loss, age, chronic cardiac disease, paralysis, and smoking in this HNCA surgical population. DVT/PE was associated with increased risk of in-hospital mortality (OR, 3.1; P = .001), postoperative surgical complications (OR, 2.1; P < .001), acute medical complications (OR, 1.9; P < .001), and was associated with significantly increased length of hospitalization and hospital-related costs.

CONCLUSIONS

DVT/PE is uncommon in HNCA patients but is associated with increased mortality, postoperative complications, length of hospitalization, and hospital-related costs. The lack of correlation with known modifiable variables suggests that despite advances in targeted prophylaxis, patients with advanced disease and comorbidity remain at increased risk. Caution must be used in the institution of reforms that threaten to inadequately reimburse the provision of care in vulnerable populations.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.

    ,

    Source

    The Laryngoscope 122:10 2012 Oct pg 2199-204

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Comorbidity
    Cross-Sectional Studies
    Female
    Head and Neck Neoplasms
    Health Care Costs
    Hospital Costs
    Hospital Mortality
    Humans
    Length of Stay
    Male
    Middle Aged
    Multivariate Analysis
    Pulmonary Embolism
    Retrospective Studies
    Surgical Procedures, Operative
    Survival Rate
    Treatment Outcome
    United States
    Venous Thrombosis

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22865644

    Citation

    Hennessey, Patrick, et al. "The Effect of Deep Venous Thrombosis On Short-term Outcomes and Cost of Care After Head and Neck Cancer Surgery." The Laryngoscope, vol. 122, no. 10, 2012, pp. 2199-204.
    Hennessey P, Semenov YR, Gourin CG. The effect of deep venous thrombosis on short-term outcomes and cost of care after head and neck cancer surgery. Laryngoscope. 2012;122(10):2199-204.
    Hennessey, P., Semenov, Y. R., & Gourin, C. G. (2012). The effect of deep venous thrombosis on short-term outcomes and cost of care after head and neck cancer surgery. The Laryngoscope, 122(10), pp. 2199-204. doi:10.1002/lary.23459.
    Hennessey P, Semenov YR, Gourin CG. The Effect of Deep Venous Thrombosis On Short-term Outcomes and Cost of Care After Head and Neck Cancer Surgery. Laryngoscope. 2012;122(10):2199-204. PubMed PMID: 22865644.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The effect of deep venous thrombosis on short-term outcomes and cost of care after head and neck cancer surgery. AU - Hennessey,Patrick, AU - Semenov,Yevgeniy R, AU - Gourin,Christine G, Y1 - 2012/08/01/ PY - 2012/04/08/received PY - 2012/04/30/revised PY - 2012/05/03/accepted PY - 2012/8/7/entrez PY - 2012/8/7/pubmed PY - 2012/12/10/medline SP - 2199 EP - 204 JF - The Laryngoscope JO - Laryngoscope VL - 122 IS - 10 N2 - OBJECTIVES/HYPOTHESIS: The Centers for Medicare and Medicaid Services has targeted deep venous thrombosis (DVT) and pulmonary embolus (PE) as preventable "never events" and has discontinued reimbursement for these conditions following selected orthopedic procedures. We sought to determine the relationship between DVT/PE and in-hospital mortality, postoperative complications, length of stay, and costs in head and neck cancer (HNCA) surgery. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Discharge data from the Nationwide Inpatient Sample for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2003 to 2008 were analyzed using cross-tabulations and multivariate regression modeling. RESULTS: DVT/PE was diagnosed in 1,860 cases (2%) and was significantly associated with major surgical procedures (odds ratio [OR], 1.4; P = .048) and advanced comorbidity (OR, 1.7; P = .034). After controlling for all other variables, no association was found between a diagnosis of DVT/PE and obesity, weight loss, age, chronic cardiac disease, paralysis, and smoking in this HNCA surgical population. DVT/PE was associated with increased risk of in-hospital mortality (OR, 3.1; P = .001), postoperative surgical complications (OR, 2.1; P < .001), acute medical complications (OR, 1.9; P < .001), and was associated with significantly increased length of hospitalization and hospital-related costs. CONCLUSIONS: DVT/PE is uncommon in HNCA patients but is associated with increased mortality, postoperative complications, length of hospitalization, and hospital-related costs. The lack of correlation with known modifiable variables suggests that despite advances in targeted prophylaxis, patients with advanced disease and comorbidity remain at increased risk. Caution must be used in the institution of reforms that threaten to inadequately reimburse the provision of care in vulnerable populations. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/22865644/The_effect_of_deep_venous_thrombosis_on_short_term_outcomes_and_cost_of_care_after_head_and_neck_cancer_surgery_ L2 - https://doi.org/10.1002/lary.23459 DB - PRIME DP - Unbound Medicine ER -