The effect of deep venous thrombosis on short-term outcomes and cost of care after head and neck cancer surgery

Abstract

Objectives/hypothesis: The Centers for Medicare and Medicaid Services has targeted deep venous thrombosis (DVT) and pulmonary embolus (PE) as preventable "never events" and has discontinued reimbursement for these conditions following selected orthopedic procedures. We sought to determine the relationship between DVT/PE and in-hospital mortality, postoperative complications, length of stay, and costs in head and neck cancer (HNCA) surgery.

Study design: Retrospective cross-sectional study.

Methods: Discharge data from the Nationwide Inpatient Sample for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2003 to 2008 were analyzed using cross-tabulations and multivariate regression modeling.

Results: DVT/PE was diagnosed in 1,860 cases (2%) and was significantly associated with major surgical procedures (odds ratio [OR], 1.4; P = .048) and advanced comorbidity (OR, 1.7; P = .034). After controlling for all other variables, no association was found between a diagnosis of DVT/PE and obesity, weight loss, age, chronic cardiac disease, paralysis, and smoking in this HNCA surgical population. DVT/PE was associated with increased risk of in-hospital mortality (OR, 3.1; P = .001), postoperative surgical complications (OR, 2.1; P < .001), acute medical complications (OR, 1.9; P < .001), and was associated with significantly increased length of hospitalization and hospital-related costs.

Conclusions: DVT/PE is uncommon in HNCA patients but is associated with increased mortality, postoperative complications, length of hospitalization, and hospital-related costs. The lack of correlation with known modifiable variables suggests that despite advances in targeted prophylaxis, patients with advanced disease and comorbidity remain at increased risk. Caution must be used in the institution of reforms that threaten to inadequately reimburse the provision of care in vulnerable populations.