Kate C. Young

How much do we need to worry about venous thromboembolism after hospital discharge? A study of colorectal surgery patients using the National Surgical Quality Improvement Program database.

PURPOSE: It is well recognized that the increased risk of a postoperative venous thrombotic event extends beyond the inpatient treatment period. The purpose of this study was to determine the 30-day incidence and risk factors associated with the occurrence of early postdischarge symptomatic venous thromboembolic events in patients who have undergone major colorectal surgery. METHODS: The National Surgical Quality Improvement Program database was queried for patients who had undergone a colon or rectal resection during the study period (2005–2008). Patient demographics, preoperative risk factors, and operative variables were recorded. The primary outcomes were occurrence of deep venous thrombosis requiring therapy or pulmonary embolism within 30 days after initial surgery. The occurrence of postdischarge venous thromboembolic events was calculated from the days to primary outcome and days from operation to discharge. Univariate and multivariate linear regression models incorporating pre- and intraoperative variables as well as the occurrence of a major or minor complication were used to evaluate the effect of these clinical factors on the early postdischarge venous thromboembolic event rate. RESULTS: A total of 52,555 patients were included in the initial analysis. A total of 240 deep venous thromboses were diagnosed in the postdischarge setting giving a postdischarge incidence of 0.47%. One hundred thirty cases of a pulmonary embolus were diagnosed (0.26% incidence) with 30 patients having a concurrent deep venous thrombosis and pulmonary embolus. The overall cumulative postdischarge symptomatic venous thromboembolic incidence was 0.67% (n = 340). Obesity, preoperative steroid use, “bleeding disorder,” ASA class III, and postoperative (major and minor) complications were all independently associated with an increased risk of an early postdischarge venous thromboembolic event. CONCLUSION: This study has identified risk factors that may help stratify patients into different risk profiles and offer prolonged prophylaxis to patients at increased risk on the basis of preoperative risk factors and postoperative complications.

A Cost-Effectiveness Analysis of Carotid Artery Stenting Compared With Endarterectomy

Endarterectomy and angioplasty with stenting have emerged as 2 alternative treatments for carotid artery stenosis. This studys objective was to determine the cost-effectiveness of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA) in symptomatic subjects who are suitable for either intervention. A Markov analysis of these 2 revascularization procedures was conducted using direct Medicare costs (2007 US

Cost-effectiveness of treating resistant hypertension with an implantable carotid body stimulator.

) and characteristics of a symptomatic 70-year-old cohort over a lifetime. In the base case analysis, CAS produced 8.97 quality-adjusted life-years, compared with 9.64 quality-adjusted life-years for CEA. The incremental cost of stenting was

Cost-effectiveness of multimodal CT for evaluating acute stroke

17,700, and thus CAS was dominated by CEA. Sensitivity analyses show that the long-term probabilities of major stroke or mortality influenced the results. In the base case analysis, CEA for patients with symptomatic stenosis has a greater benefit than CAS, with lower direct costs. With 59% probability, CEA will be the optimal intervention when all of the model assumptions are varied simultaneously.

Cost-effectiveness of abdominal aortic aneurysm repair based on aneurysm size

The purposes of this study are to investigate the cost‐effectiveness of an implantable carotid body stimulator (Rheos; CVRx, Inc, Minneapolis, MN) for treating resistant hypertension and determine the range of starting systolic blood pressure (SBP) values where the device remains cost‐effective. A Markov model compared a 20‐mmu2003Hg drop in SBP from an initial level of 180 mm Hg with Rheos to failed medical management in a hypothetical 50‐year‐old cohort. Direct costs (2007

Prediction of postdischarge venous thromboembolism using a risk assessment model

), utilities, and event rates for future myocardial infarction, stroke, heart failure, and end‐stage renal disease were modeled. Sensitivity analyses tested the assumptions in the model. The incremental cost‐effectiveness ratio (ICER) for Rheos was

Evidence-based treatment of carotid artery stenosis

64,400 per quality‐adjusted life‐years (QALYs) using Framingham‐derived event probabilities. The ICER was <

Hospital Resource Use Following Carotid Endarterectomy in 2006: Analysis of the Nationwide Inpatient Sample

100,000 per QALYs for SBPs ≥142 mm Hg. A probability of device removal of <1% per year or SBP reductions of ≥24u2003mmu2003Hg were variables that decreased the ICER below

Does current practice in the United States of carotid artery stent placement benefit asymptomatic octogenarians

50,000 per QALY. For cohort characteristics similar to Anglo‐Scandinavian Cardiac Outcomes Trial–Blood Pressure–Lowering Arm (ASCOT‐BPLA) participants, the ICER became

The Cost-Utility of CT Angiography and Conventional Angiography for People Presenting with Intracerebral Hemorrhage

26,700 per QALY. Two‐way sensitivity analyses demonstrated that lowering SBP 12u2003mmu2003Hg from 220 mm Hg or 21u2003mmu2003Hg from 140 mm Hg were required. Rheos may be cost‐effective, with an ICER between