Presentation Details
| Healthcare Burden of Venous Thromboembolism in Hospitalized Cancer Patients: Nationally Representative Estimates Using the Largest All-payer Inpatient Database in the United States Krish Khurana1, Giuseppe Maiocco2, Nareg H.Roubinian3, Mohammad Hussain2, Waqas Azhar2, Sujitha Ketineni2, Hareena Sangha4, Michael B.Streiff5, Aaron A.R.Tobian5, Ruchika Goel2, 5, 6. 1Southern Illinois School of Medicine P4P program, Springfield, IL, USA.2Southern Illinois School of Medicine, Springfield, IL, USA.3Vitalant Research Institute, San Francisco, CA, USA.4University of Texas Southwestern School of Medicine, Dallas, TX, USA.5Johns Hopkins University School of Medicine, Baltimore, MD, USA.6Vitalant Corporate Medical Affairs, Scottsdale, AZ, USA |
Abstract
INTRODUCTION: Among cancer associated hospitalizations, venous thromboembolism (VTE) [deep vein thrombosis (DVT)/pulmonary embolism (PE)] is a leading non-cancer cause of death. Data on co-diagnosis and healthcare impact of cancer associated thromboses vary, yet higher risk is known to be associated with specific cancer types, treatments, and comorbidities. This study utilizes a nationally representative database to report the co-diagnosis, mortality, and healthcare burden of VTE in cancer hospitalizations in the United States (US). METHODS: The Nationwide Inpatient Sample Healthcare Cost and Utilization Project (HCUP-NIS) is the largest all-payer inpatient database in the US, approximating a 20% stratified sample of inpatient discharges from >5000 hospitals across 48 states. Data from the 2020 HCUP-NIS was used to generate nationally representative estimates of cancer associated thrombotic events; CCSR and ICD-10 codes were used to identify hospital discharges in which co-diagnoses of any cancer type and VTE were listed. Age and gender adjusted Odds Ratios (aOR) were calculated and statistical comparisons of proportions and medians as applicable were performed via STATA V18.0. RESULTS: Of 31,297,020 US hospitalizations in 2020; 2,920,670 (9.3%) had cancer a listed diagnosis (Table 1). Of these, 221,205 (7.6%) had co-diagnosis of VTE [89,650(41%) PE, 163,430(74%) DVT, and 31,875(14%) both PE and DVT]. Median age (interquartile range (IQR)) for admissions with cancer and VTE was 67(58-75) years with 86.5% admissions classified as having major/severe underlying illness. VTE in cancer occurred at significantly higher rates than general admissions (aOR(95%CI) (aOR)=2.37(2.34-2.40);p<.0001) [PE (aOR(95%CI)=2.05(2.01-2.09);p<.0001, Table 1); DVT (aOR(95%CI)=2.48(2.45-2.52);p<.0001)]. Incidence varied by cancer subtype, with VTE being most common in liver (17.5%), pancreatic (15.3%), bile duct (14.0%), adrenocortical (13.4%), cardiac (13.2%), gallbladder (12.6%), Uterine (12.2%), Testicular (11.8%) and Endometrial (10.5%)cancer admissions. MORTALITY: Overall rates of all-cause mortality were elevated in cancer hospitalizations compared to general admissions (5.7% vs. 2.8%, aOR=1.54(1.52-1.56);p<.0001), Figure 1). Further, among cancer hospitalizations, odds of all-cause mortality for cancer admissions with VTE was higher as compared to without VTE (aOR=1.91(1.84-1.99);p<.0001). All-cause mortality among cancer hospitalizations was higher independently for both DVT (aOR=1.68(1.61-1.76);p<.0001) and PE (aOR=2.19(2.07-2.31);p<.0001). HEALTHCARE BURDEN: Cancer hospitalizations with VTE were associated with significantly longer median(IQR) length of stay than cancer without VTE [6(3-11)days versus 4(2-8)days; (p<.0001)] and higher hospital charges [$64,983($32,907-$137,615) versus $52,501($28,117-$99,894);p<.0001)]. CO-DIAGNOSES/PROCEDURES: Most common co-diagnoses in admissions with cancer and VTE included hyperlipidemia (56.8%), secondary metastasis (46.2%), hypertension (35.9%), anemia (34.4%), and renal failure (28.4%) (Figure 2). Highest coded procedural interventions in cancer and VTE admissions were RBCs or platelet transfusion (14.1%), respiratory ventilation (10.9%), airway insertion (6.6%), antineoplastic therapy (5.8%), and endoscopy/colonoscopy (4.3%) (Figure 2). CONCLUSIONS: These nationally representative data show that VTE is a frequent complication among hospitalized patients with cancer and highest co-diagnoses being reported in admissions with gastro-intestinal and genito-urinary cancers and those with metastasis. VTE in cancer is associated with significantly higher all-cause mortality, length of hospitalization, and total hospital expenditures than cancer admissions without VTE. These findings highlight the healthcare burden of cancer associated venous thromboses.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
Content Locked. Log into a registered attendee account to access this presentation.