Incidences and variations of hospital acquired venous thromboembolism in Australian hospitals: a population-based study
Incidences and variations of hospital acquired venous thromboembolism in Australian hospitals: a population-based study
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DOI：
10.1186/s12913-016-1766-y
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发表时间：
2016-09-22
影响因子：
2.8
通讯作者：
Flabouris, Arthas
中科院分区：
文献类型：
--
作者：
Assareh, Hassan;Chen, Jack;Flabouris, Arthas
背景：缺乏关于医院获得性静脉血栓栓塞 (HA-VTE) 发病率、病死率以及患者群体和医疗服务提供者之间差异的数据。我们的目标是探讨澳大利亚新南威尔士州 (NSW) 所有急症医院的 HA-VTE 发生率、相关死亡率、趋势和变化。 方法：一项基于人群的研究，使用 2002 年至 2009 年新南威尔士州 104 家急症公立和私立医院的所有入院患者（年龄 18-90 岁，住院时间至少两天且未转至其他急症护理机构）。使用泊松混合模型在存在患者和医院特征的情况下得出调整率比 (IRR)。 结果：在 3,331,677 名患者中，HA-VTE 的发生率为每 1000 名患者 11.45 例，发生 HA-VTE 的患者中有十分之一在医院死亡。 HA-VTE 发病率最初上升，但随后下降，而病死率在研究期间持续下降 22%。与内科患者相比，手术患者发生 HA-VTE 的可能性高出 128%（IRR = 2.28，95% CI：2.19-2.38），但病死率相似。与公立医院相比，私立医院内科患者的 HA-VTE 发生率更高（IRR = 1.76；95% CI：1.42-2.18）。然而，手术患者的发病率相似（IRR = 0.91；95% CI：0.75-1.11），但死亡率较低（IRR = 0.59；95% CI：0.47-0.75）。与大型医院相比，小型公立医院的 HA-VTE 发病率较低（IRR < 0.68），但病死率较高（IRR > 1.71）。 HA-VTE 发生率报告较低的医院往往具有较高的 HA-VTE 病死率。结论：尽管 HA-VTE 发生率和病死率有所下降，但内科和外科患者、公立和私立医院以及不同医院集团之间的事件存在很大差异。这种差异的原因值得进一步调查，并可能为有针对性的干预措施和质量改进举措提供潜力。
Background: Data on hospital-acquired venous thromboembolism (HA-VTE) incidence, case fatality rate and variation amongst patient groups and health providers is lacking. We aim to explore HA-VTE incidences, associated mortality, trends and variations across all acute hospitals in New South Wales (NSW)-Australia.Methods: A population-based study using all admitted patients (aged 18-90 with a length of stay of at least two days and not transferred to another acute care facility) in 104 NSW acute public and private hospitals during 2002-2009. Poisson mixed models were used to derive adjusted rate ratios (IRR) in presence of patient and hospital characteristics.Results: Amongst, 3,331,677 patients, the incidence of HA-VTE was 11.45 per 1000 patients and one in ten who developed HA-VTE died in hospital. HA-VTE incidence, initially rose, but subsequently declined, whereas case fatality rate consistently declined by 22 % over the study period. Surgical patients were 128 % (IRR = 2.28, 95 % CI: 2.19-2.38) more likely to develop HA-VTE, but had similar case fatality rates compared to medical patients. Private hospitals, in comparison to public hospitals had a higher incidence of HA-VTE (IRR = 1.76; 95 % CI: 1.42-2.18) for medical patients. However, they had a similar incidence (IRR = 0.91; 95 % CI: 0.75-1.11), but a lower mortality (IRR = 0.59; 95 % CI: 0.47-0.75) amongst surgical patients. Smaller public hospitals had a lower HA-VTE incidence rate compared to larger hospitals (IRR < 0.68) but a higher case fatality rate (IRR > 1.71). Hospitals with a lower reported HA-VTE incidence tended to have a higher HA-VTE case fatality rate.Conclusion: Despite the decline in HA-VTE incidence and case fatality, there were large variations in incidents between medical and surgical patients, public and private hospitals, and different hospital groups. The causes of such differences warrant further investigation and may provide potential for targeted interventions and quality improvement initiatives.