Pharmacy & Therapeutics - February 2008 - (Page 100)

Antifibrinolytic Therapy in Cardiothoracic Surgery Table 1 Diagnostic Related Groupings (DRGs) Mapped to UHC’s Cardiothoracic Surgery Product Line DRG DRG Description 075 076 077 104 105 Major Chest Procedures Other Respiratory System Operating Room Procedures with CC Other Respiratory System Operating Room Procedures without CC Cardiac Valve Procedures and Other Major Cardiothoracic Procedures with Cardiac Catheterization Cardiac Valve Procedures and Other Major Cardiothoracic Procedures without Cardiac Catheterization Coronary Bypass with PTCA (Fiscal Year 1999+) Coronary Bypass with Cardiac Catheterization (Fiscal Year 1999+) Other Cardiothoracic Procedures Coronary Bypass without Cardiac Catheterization (Fiscal Year 1999+) Major Cardiovascular Procedures with CC Major Cardiovascular Procedures without CC Permanent Cardiac Pacemaker Implant with aMI/HF/Shock or AICD Lead or General Procedure Other Cardiac Pacemaker Implantation Cardiac Pacemaker Revision Except Device Replacement Cardiac Pacemaker Device Replacement Cardiac Defibrillator Implant w Cardiac Catheterization Cardiac Defibrillator Implant w/o Cardiac Catheterization Heart Assist System Implant Cardiac Defibrillator Implant with Cardiac Catheterization with aMI/HF/Shock Cardiac Defibrillator Implant with Cardiac Catheterization without aMI/HF/Shock CABG with Cardiac Catheterization with MCV Diagnosis CABG with Cardiac Catheterization without MCV Diagnosis CABG without Cardiac Catheterization with MCV Diagnosis CABG without Cardiac Catheterization without MCV Diagnosis Permanent Cardiac Pacemaker Implant with MCV Diagnosis or AICD Lead or Generator Other Permanent Cardiac Pacemaker Implant without MCV Diagnosis in the pediatric population. All of the surveyed institutions except one had aprotinin on their formularies, and more than 50% had prescribing restrictions. Most of the survey respondents (18 of 21) indicated that they were re-evaluating the use of aprotinin and were considering restrictions. Approximately 50% of the institutions had restrictions in place. More than two-thirds of the respondents stated that aprotinin use was not on the agenda of the next P&T committee meeting, but two respondents were thinking about removing it from their formularies. As a result of these preliminary findings, we decided to investigate the available patient information in the Clinical Data Base of the University HealthSystem Consortium (UHC) on the use of aprotinin, TA, or AA and possible related adverse effects in CTS patients who were discharged from academic health centers over the most recent three-year period for which data were available. 106 107* 108 109* 110 111 115* 116* 117 118 514* 515 525 535 536 547 548 549 550 551 552 Methods Our study was based on a retrospective review of data from a nationally representative sample of academic health centers participating in UHC’s Clinical Resource Manager (CRM) Data Base. The CRM is an electronic repository of data gathered from participant hospitals’ inpatient discharge summaries, Uniform Billing (UB-92) forms, charge masters, and detailed billing files. We performed a search of all hospitalized patients discharged between October 1, 2002, and September 30, 2005 (12 quarters), who received either aprotinin, AA, or TA. Only hospitals with contributing data from all 12 quarters were included in the analysis. Enrollment was not restricted by age, but patients receiving more than one antifibrinolytic agent were excluded from further analysis. Patient identifiers were masked to maintain confidentiality and privacy. We identified the patients who were using antifibrinolytic agents and undergoing CTS as defined by their Diagnostic Related Grouping (DRG). We also examined CTS–CABG patient subgroups (Figure 1; see page 99). Table 1 presents the complete list of DRGs that are mapped into CTS by UHC. Study Variables We obtained demographic variables from the CRM, including the patient’s age, sex, and race; the DRG assignment; and whether CABG surgery was performed. We referred to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), procedure code 36.1x. Selected patient comorbidities (flagged by the Agency for HealthCare Research and Quality’s Comorbidity Software, Version 3.1) included the presence of: • hypertension (ICD-9-CM codes 401.1, 401.9, and 642.00–642.04). • peripheral vascular disorders (ICD-9-CM codes 440.0– 442.9, 443.1–443.9, 447.1, 557.1, 557.9, and V43.4). • diabetes without chronic complications (ICD-9-CM codes 250.00–250.33 and 648.00–648.04). • diabetes with chronic complications (ICD-9-CM codes 250.40–250.93 and 775.1). * These DRGs are no longer valid, but they might have been used during this particular study period. AICD = automatic internal cardiac defibrillator; aMI = acute myocardial infarction; CABG = coronary artery bypass grafting; CC = complications and comorbidities; HF = heart failure; MCV = major cardiovascular conditions; PTCA = percutaneous coronary angioplasty. 100 P&T® • February 2008 • Vol. 33 No. 2

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Pharmacy & Therapeutics - February 2008 Contents Editorial Medication Errors Prescription: Washington The Language of (Forgive Us) Change, As P&T Enters the Digital Age New Drugs/Drug News/New Medical Devices Drug Forecast Use and Outcomes of Antifibrinolytic Therapy in Patients Undergoing Cardiothoracic Surgery at 20 Academic Medical Centers in the United States Evaluation of the Management of Acute Venous Thromboembolism and Its Outcomes: One Institution's Experience American Society of Hematology, 49th Annual Meeting Pharmaceutical Approval Update

Pharmacy & Therapeutics - February 2008

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