Burnand, B.

Colin, C.

Ghali, WA

Hider, PN

Januel, JM

Romano, PS

White, RH

English

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Determinants of venous thromboembolic event ratesafter hip arthroplasty -international comparisonBernard BurnandJM Januel1, WA Ghali2, PS Romano3, RH White3, PN Hider4, C Colin5,B Burnand61Institut universitaire de formation et de recherche en soins, LausanneUniversity Hospital, Lausanne, Switzerland2Department of Community Health Sciences, University of Calgary, Calgary,Canada3Department of General Medicine, University of California Davis,Sacramento - CA, USA4Department of Public Health and General Practice, University of Otago,Christchurch, New Zealand5Poˆle d’information me´dicale e´valuation recherche, Hospices Civils, Lyon,France6Institute of social and preventive medecine, Lausanne University Hospital,Lausanne, SwitzerlandContact: Bernard.Burnand@chuv.chBackgroundInternational comparisons of indicators of healthcare perfor-mance, quality and safety provide an important opportunity toexplore reasons for their variations in order to find ways toimprove both the indicators and the quality of care. We aimedto compare rates of hospital adverse events internationally andto investigate possible clinical and health system determinantsof their variations.MethodsWe used hospital discharge diagnoses to measure ratesof symptomatic venous thromboembolic events (VTE)in patients hospitalized for hip arthroplasty in Canada,France, New-Zealand, Switzerland and the USA. We usedthese coded diagnoses to measure VTE rates using anexisting algorithm (AHRQ Patient Safety Indicator 12).We examined associations between VTE and gender, age,length of stay (LOS), number of discharge diagnoses recorded(Ndiag), and performance of ultrasonography before discharge(US).ResultsVTE rates were 0.84% in Canada, 1.41% in France, 0.84% inNew-Zealand, 0.37% in Switzerland, 0.66% in the USA. Age,gender, LOS, Ndiag and US could have influenced VTE rates.For instance, France, where the highest VTE rate was observed,was also the only country with routine reported use of USbefore discharge (>17% vs <1% in other countries), which waseven more frequent in private hospitals. The mean value ofNdiag was close to 7 in the USA, and varied between 2 and 3 inthe other countries.ConclusionsVTE rates varied across countries. These differences could belinked to differences in coding practices, as well as differencesin clinical and health systems determinants (e.g., highersystematic US assessment in France and probable increasednumber of asymptomatic VTE coded). The interpretation ofdifferences in international comparisons of healthcare asso-ciated VTE rates should be cautious; possible determinants ofthese differences should be considered.Key messages Understanding and reducing heterogeneity in internationalcomparisons of adverse events of healthcare is crucial Caution is needed when interpreting international compar-isons of adverse events of healthcare200 European Journal of Public Health, Vol. 25, Supplement 3, 2015

Determinants of venous thromboembolic event rates after hip arthroplasty -international comparison: Bernard Burnand

http://doc.rero.ch/record/293439/files/ckv172.073.pdf

Determinants of venous thromboembolic event rates after hip arthroplasty -international comparison: Bernard Burnand

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