Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Apr;135(4):636-42.
doi: 10.1016/j.thromres.2015.01.026. Epub 2015 Jan 26.

Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005-2010

Richard E Nelson  1 , Scott D Grosse  2 , Norman J Waitzman  3 , Junji Lin  4 , Scott L DuVall  5 , Olga Patterson  6 , James Tsai  7 , Nimia Reyes  8
Affiliations

Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005-2010

Richard E Nelson et al. Thromb Res. 2015 Apr.

Abstract

Background: There are limitations to using administrative data to identify postoperative venous thromboembolism (VTE). We used a novel approach to quantify postoperative VTE events among Department of Veterans Affairs (VA) surgical patients during 2005-2010.

Methods: We used VA administrative data to exclude patients with VTE during 12 months prior to surgery. We identified probable postoperative VTE events within 30 and 90 days post-surgery in three settings: 1) pre-discharge inpatient, using a VTE diagnosis code and a pharmacy record for anticoagulation; 2) post-discharge inpatient, using a VTE diagnosis code followed by a pharmacy record for anticoagulation within 7 days; and 3) outpatient, using a VTE diagnosis code and either anticoagulation or a therapeutic procedure code with natural language processing (NLP) to confirm acute VTE in clinical notes.

Results: Among 468,515 surgeries without prior VTE, probable VTEs were documented within 30 and 90 days in 3,931 (0.8%) and 5,904 (1.3%), respectively. Of probable VTEs within 30 or 90 days post-surgery, 47.8% and 62.9%, respectively, were diagnosed post-discharge. Among post-discharge VTE diagnoses, 86% resulted in a VA hospital readmission. Fewer than 25% of outpatient records with both VTE diagnoses and anticoagulation prescriptions were confirmed by NLP as acute VTE events.

Conclusion: More than half of postoperative VTE events were diagnosed post-discharge; analyses of surgical discharge records are inadequate to identify postoperative VTE. The NLP results demonstrate that the combination of VTE diagnoses and anticoagulation prescriptions in outpatient administrative records cannot be used to validly identify postoperative VTE events.

Keywords: Deep vein thrombosis; Pulmonary embolism; Surgery; Venous thromboembolism; Veterans.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Cohort attrition summary.
Fig. 2
Fig. 2
a: Kaplan-Meier curve for postoperative DVT events. b: Kaplan-Meier curve for postoperative PE events.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Streiff MB, Brady JP, Grant AM, Grosse SD, Wong B, Popovic T, et al. CDC Grand Rounds: preventing hospital-associated venous thromboembolism. MMWR Morb Mortal Wkly Rep. 2014;63:190–3. - PMC - PubMed
    1. Hooper WC, Evatt BL. The role of activated protein C resistance in the pathogenesis of venous thrombosis. Am J Med Sci. 1998;316:120–8. - PubMed
    1. Piazza G, Goldhaber SZ. Venous thromboembolism and atherothrombosis: an integrated approach. Circulation. 2010;121:2146–50. - PubMed
    1. Heit JA, Silverstein MD, Mohr DN, Petterson TM, Lohse CM, O’Fallon WM, et al. The epidemiology of venous thromboembolism in the community. Thromb Haemost. 2001;86:452–63. - PubMed
    1. Spencer FA, Emery C, Joffe SW, Pacifico L, Lessard D, Reed G, et al. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb Thrombolysis. 2009;28:401–9. - PMC - PubMed

Publication types