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Postoperative venous thromboembolic events
Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).
2.26 Percent surgical discharges with postoperative venous thromboembolic events, United States, 2002 and 2003.
- CMS, MPSMS, inpatient medical records: for abstracted data related to the index hospital stay.
- CMS Medicare Administrative Data: used to identify a major surgical procedure, for 30-day post-procedure readmission diagnosis of deep vein thrombosis (DVT) or pulmonary embolism (PE) and for 30-day post-procedure and post-discharge mortality.
All discharges from the MPSMS sample that had 1 or more of certain surgical procedures identified as part of the Surgical Care Improvement Project during the index hospital stay.
The subset of the denominator with a diagnosed PE or DVT during the index hospital stay (per medical record abstraction) or readmission to the hospital post-index hospital stay for a PE or DVT within 30 days of the surgical procedure (per Medicare administrative data ICD-9-CM diagnosis codes 415.11, 415.19, 451.1, 451.2, 451.81, 451.83, 451.84, 451.89, 453.1, 453.2, 453.8, and 453.9).
Venous thromboembolic events (VTE) include at least 1 of the following:
- deep venous thromboses (thromboses or occlusions within the venous system, most commonly of the lower extremities)
- Pulmonary emboli: Obstructions of the pulmonary artery vasculature usually arising from thrombi in the deep venous system of the lower extremities
Diagnostic criteria for DVT include at least 1 of the following:
- Physician diagnosis of a DVT
- An abnormal compression Duplex or Doppler ultrasonography, contrast venography, impedence plethysmography (IPG), or magnetic resonance venography (MR)
Diagnostic criteria for PE include a clinical index of suspicion and at least 1 of the following:
- High probability ventilation-perfusion (V/Q) scan
- Moderate probability V/Q scan and abnormal duplex US of the lower extremities or lower extremity venogram
- Abnormal helical (spiral) computerized tomographic (CT) exam of the pulmonary arteries indicating pulmonary embolus
- Abnormal pulmonary angiography indicating pulmonary embolus
- Abnormal magnetic resonance angiography (MR) exam of the pulmonary arteries indicating pulmonary embolus
In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.
For more detailed information regarding the Surgical Care Improvement Project go to http://www.medqic.org/scip/.