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Epidemiology and Predictors of Outcome of Postphlebitic Syndrome
Abdallah Naddaf, MD, Nick Nolte, MD, Imran Khan, MD, James Pan, MD, Douglas Hood, MD, Kim J. Hodgson, MD, Sapan S. Desai, MD, PhD, MBA.
Southern Illinois University, Springfield, IL, USA.
OBJECTIVES:
Postphlebitic syndrome (PPS) is the most common complication of lower extremity deep vein thrombosis (DVT), affecting up to one half of patients. PPS is associated with significant patient morbidity and increased healthcare costs. The aim of this paper is to evaluate the epidemiology and demographics of patients admitted for lower extremity PPS, and to determine risk factors that impact outcome. A risk score to identify at-risk patients was developed.
METHODS:
A retrospective analysis was completed using the Nationwide Inpatient Sample (NIS) from 2002 to 2011. Patients with lower extremity PPS were identified using ICD-9 codes. Epidemiology, demographics, comorbidities, hospital covariates, and outcomes were determined. Statistically significant variables and odds ratios were identified by multivariate analysis. A discriminant function and the area under the receiver operating characteristic curve (AUC) were used to identify factors predictive of surgical intervention.
RESULTS:
The overall incidence of inpatient PPS is 3.1/100,000 and has been decreasing since 2002. The average age of patients with PPS is 61.2 years, with 48.3% female. Patients diagnosed with PPS with complications (37.8%) such as ulcers are more likely to undergo an intervention such as venogram (P>0.05), stent (P0.05), venous bypass (P>0.05), vein stripping (P<0.001), or wound debridement (P<0.001). The median length of stay (LOS) is greater for patients who have PPS with complications (5 vs. 4, P<0.01), and median cost of care is greater (,293 vs. ,399, P<0.001). Inpatient mortality is greater for those who have PPS with complications (0.8% vs. 0.4%, P<0.01). PPS with any complication, age under 60, urban hospital location, and peripheral vascular disease are risk factors that predict the need for intervention.
CONCLUSIONS:
PPS is a disabling disease with little known about its true epidemiology and risk factors. PPS with complications is a major predictor of future interventions and resource burden. The ability to identify at-risk patients may better guide resource allocation and mitigate the effects of complications from PPS.
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