Nationally representative estimates of health care burden of venous thromboembolism in hospitalized cancer patients

Importance Venous thromboembolism (VTE) is a frequent and often preventable cancer-related co-morbidity. This study evaluates national healthcare burden of patients hospitalized with cancer and VTE diagnoses. Methods The 2021 Nationwide Inpatient Sample (NIS) was used to generate nationally representative estimates of cancer-associated thrombotic events identified via International Classification of Diseases-10 coding. Adjusted odds ratios (aOR) for co-diagnosis rate and all-cause mortality, median hospital charges and length-of-stay (LOS) for cancer admissions with and without VTE were calculated. Results Of 28,443,009 adult US hospitalizations in 2021; 2,907,118(10.2%) listed cancer as a diagnosis. Of these, 234,090(8.1%) had co-diagnosis of VTE [96,335(41%) PE, 172,315(74%) DVT, and 34,560(15%) both PE and DVT]. Median age(interquartile range) for admissions with cancer and VTE was 67(58-76) years with 87.6% admissions classified as major/severe underlying illness. VTE and cancer occurred at significantly higher rates than non-cancer admissions (aOR(95%CI) (aOR)=1.81(1.79-1.83);p<0.001) [PE (aOR(95%CI)=1.54(1.51-1.56);p<0.001); DVT (aOR(95%CI)=1.94(1.91-1.96);p<0.001)]. Odds of all-cause mortality for cancer admissions with VTE was higher as compared to without (aOR=1.61(1.56-1.67);p<0.001)[DVT(aOR=1.41(1.36-1.47);p<0.001) and PE(aOR=1.88(1.79-1.97);p<0.001). Analysis by race found blacks had elevated VTE odds(aOR(95%CI) (aOR)=1.29(1.26-1.33);p<0.001), and blacks with VTE had elevated mortality odds(aOR(95%CI) (aOR)=1.15(1.11-1.19);p<.001), compared to non-black admissions. Cancer hospitalizations with VTE were associated with significantly longer median(IQR) LOS [6(3-11)days versus 4(2-8)days;(p<0.001)] and higher median hospital charges [$70,416($36,257-$146,218) versus $55,887($30,276-$105,637);p<0.001)]. Conclusions This report on contemporary national data shows co-diagnosis of VTE and cancer is associated with significantly higher all-cause mortality, LOS, and total hospital expenditures than cancer admissions without VTE. These findings underscore importance of accurate VTE risk assessment for inpatients with cancer.