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The effect of deep venous thrombosis on short-term outcomes and cost of care after head and neck cancer surgery.
Laryngoscope 2012; 122(10):2199-204L

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.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.No affiliation info availableNo affiliation info available

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 -