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Research Letter |

No Association Between Hospital-Reported Perioperative Venous Thromboembolism Prophylaxis and Outcome Rates in Publicly Reported Data

Eric A. JohnBull, MPH1; Brandyn D. Lau, MPH, CPH1; Eric B. Schneider, PhD2; Michael B. Streiff, MD3,4,5; Elliott R. Haut, MD1,2,5,6,7
[+] Author Affiliations
1Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
3Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
4Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
5Armstrong Institute for Patient Quality and Safety, Johns Hopkins University School of Medicine, Baltimore, Maryland
6Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
7Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Surg. 2014;149(4):400-401. doi:10.1001/jamasurg.2013.4935.
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Venous thromboembolism (VTE), consisting of deep vein thrombosis (DVT) and pulmonary embolism, is an important cause of postoperative mortality and long-term morbidity. Because many events are preventable, VTE prophylaxis performance and postoperative VTE are used as measures of hospital quality of care and patient safety. Two such metrics are reported on the Centers for Medicare & Medicaid Services Hospital Compare website (http://www.medicare.gov/hospitalcompare/search.html) with the stated goal of helping consumers make decisions about where to receive their health care.

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Figure 1.
Risk-Adjusted AHRQ PSI-12 Postoperative VTE Rate vs Percentage of Patients Who Received SCIP VTE-2 Prophylaxis

Linear regression (3040 hospitals) of VTE rate on percentage of surgical patients receiving timely VTE prophylaxis did not show a significant association (95% CI, −1.65% to 13.35%; P = .13). The horizontal red line represents the simple linear regression line. AHRQ indicates Agency for Healthcare Research and Quality; PSI, Patient Safety Indicator; SCIP, Surgical Care Improvement Project; and VTE, venous thromboembolism.

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Figure 2.
Risk-Adjusted AHRQ PSI-12 Postoperative Venous VTE Rate vs Percentage of Patients Who Received SCIP VTE-2 Prophylaxis, by Quintile

The Kruskal-Wallis rank test was used to determine the equality of population distributions (P = .04). None of the Bonferroni-corrected rank sum tests for pairwise comparisons of quintiles were statistically significant (all P > .005). The horizontal line in the middle of each box indicates the median, whereas the top and bottom borders of the box mark the 75th and 25th percentiles, respectively. The whiskers above and below the box are Tukey fences marking the most extreme observed values within 1.5 times the interquartile range above the 75th and below the 25th percentiles. AHRQ indicates Agency for Healthcare Research and Quality; PSI, Patient Safety Indicator; SCIP, Surgical Care Improvement Project; and VTE, venous thromboembolism.

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