Morbidity, mortality and costs associated with venous thromboembolism in hospitalized patients with cancer

Background: Venous thromboembolism (VTE) represents a leading cause of morbidity and mortality among patients with cancer. Methods: Hospitalization data reported on adult cancer patients at US medical centers between 1995 and 2012 were analyzed. Cancer diagnosis, presence of VTE, comorbidities, and infectious complications were based on ICD-9-CM codes. Results: Nearly six million hospitalizations of 3,146,388 individual patients with cancer were reported with VTE observed in 8.4%. A single hospitalization was randomly selected for each patient with VTE diagnosed in 166,537 (5.3%) of evaluated admissions. In-hospital mortality was observed in 5.5% of patients without a VTE diagnosis and in 15.0% of those with VTE including 19.4% with a pulmonary embolism. While rates of VTE increased from 3.5% in 1995 to 6.5% in 2012, no significant reported changes in VTE imaging, length of stay (LOS) or intensive care unit (ICU) admissions were observed and mortality decreased by one-third. VTE was reported in 5.2%, 5.8% and 5.4% of patients with solid tumors, lymphoma, and leukemia, respectively. Rates of VTE were greatest among patients with pancreatic, gastric or other abdominal malignancies as well as those with ovarian, lung and esophageal cancers. The risk of VTE increased progressively from 2.3% in those with no comorbidities to over 11% in those with 3 major comorbidities. The strongest risk factors for VTE were infectious complications including sepsis, invasive candidiasis, pneumonia and IV line infections. Average costs per hospitalization adjusted to 2015 dollars for patients without and with VTE were $19,994 and $37,352, respectively. Conclusions: VTE among hospitalized patients with cancer has increased significantly with a major impact on hospital mortality and costs. Patients with major medical comorbidities and infectious complications are at particularly high risk.