Abstract
Introduction: Venous thromboembolism (VTE) is a major cause of mortality and morbidity in hospitalized patients. Cancer patients are particularly at risk for VTE. Nationwide Inpatient Sample (NIS) database was analyzed to determine the trends in the rate of hospitalization and mortality from VTE in hospitalized ovarian cancer patients and assess its impact.
Method: We queried the 2003-2011 Nationwide Inpatient Sample database from Healthcare Cost and Utilization project(AHRQ) to identify all adults (age ≥ 18 years) with ovarian cancer. Ovarian cancer patients hospitalized with VTE as one of the top three-discharge diagnosis were identified. Demographic characteristics and in-hospital outcomes of this population were compared to ovarian cancer patients without VTE. Binary logistic regression analysis was used to obtain adjusted odds ratios (OR).
Results: 34,249 (3.5%) of a total of 981,386 hospitalized ovarian cancer patients had an accompanying diagnosis of VTE. Mean age of the study population was 64 years. 79% of the study population were Caucasian, however, the rate of VTE was higher in African Americans as compared to Caucasians (4.5% vs 3.4%). 21% of the study population had distant metastasis and was more likely in the VTE cohort (36.9% vs 20.4%). Other descriptive characteristic, insurance type and hospital characteristic are listed in Table 1. After adjusting for potential confounders, compared to those without VTE, ovarian cancer patients with VTE had significantly higher inpatient mortality (6.2 % vs. 4.3 %, OR 1.12 (CI 1.06 - 1.17), p <0.001), longer length of stay (LOS) (5 vs 4 days, OR 1.40 (CI 1.36 - 1.43), p<0.001), higher average cost of hospitalization ($26000 vs $22000, OR 1.10 (CI 1.07 - 1.13), p <0.001) and greater disability at discharge (OR = 1.34 (CI 1.31 - 1.38), p < 0.001) (Table 2,3). Although the annual number of VTE admissions in ovarian cancer patients increased, in-hospital mortality declined from 10.9% in 2003 to 5.3% in 2011.
Conclusion: VTE in hospitalized patients with ovarian cancer is associated with higher inpatient mortality, disability at discharge, LOS and higher cost of hospitalization. African American Patients and presence of metastatic disease may be associated with an increased risk of VTE. The hospitalization rate has increased but the inpatient mortality rate has declined over this study period. This cross sectional study would help in the development and implementation of appropriate prophylactic strategies in high-risk ovarian cancer patients.
No relevant conflicts of interest to declare.
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