Published results showed a significantly increased risk for development of venous thromboembolism among patients with pelvic and lower extremity fractures who underwent interfacility transfer.
Kenneth Egol , MD, chief of orthopedic trauma surgery and the Joseph E. Milgram Professor of Orthopedic Surgery at NYU Langone Health, and colleagues categorized 690 patients who received definitive care for a lower extremity fracture into groups based on whether the patient was admitted directly from the emergency department (n=564) or was transferred from another facility (n=126). Researchers recorded patient age, sex, American Society of Anesthesiologist classification, fracture type and length of stay in both groups, and determined time at outside hospital, time from transfer to definitive fixation, length of stay at each institution and total time from injury to discharge in the transfer group. Researchers also recorded incidence, type and timing of VTE.
With regard to age, sex, length of stay and American Society of Anesthesiologist score, results showed no significant differences between the transfer and direct administration group. Researchers noted a significantly higher incidence of VTE of 9.5% in the transfer group vs. 0.7% in the direct administration group. Patients in the transfer group also experienced longer time to surgery, according to results. Researchers did not find complete and explicit documentation regarding thromboprophylaxis administration while at an outside facility among the transfer group.
“The basic idea is that the government and insurance companies are penalizing doctors and hospitals for certain ‘avoidable’ conditions. Many patients who are complicated and [are] high risk, transfer for higher levels of care,” Egol told Healio.com/Orthopedics. “What we have shown is that the [venous thromboembolism] VTE has more to do with the transferring facility, and the accepting facility will be on the hook of this complication. Thus, it is important to look for these upon admission to avoid penalties for the accepting facility and physicians.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.