30-day readmissions for venous thromboembolism and pulmonary embolism in patients with pancreatic cancer: A national population-based study.

Abstract

e16318 Background: Pancreatic cancer patients have a strong risk of Deep Venous thrombosis (DVT). Pulmonary Embolism (PE) can be a fatal complication of DVT. Both DVT/PE increases the risk of hospitalization and subsequent readmission. National population-based studies are scarce on DVT/PE readmissions among pancreatic cancer patients in the United States (U.S). In this study, we aim to describe the rate, reasons for readmissions, and outcome of readmissions for pancreatic cancer patients hospitalized for DVT/PE in the U.S. Methods: We analyzed the 2018 Nationwide Readmissions Database (NRD). It includes nested and weighted discharge data for 60% of the total U.S population from 28 states. These data are stratified in clusters to produce national estimates. The NRD captures admissions on a calendar-year basis without links to the following or preceding year. We included index hospitalizations for all pancreatic cancer patients (aged ≥18 years) admitted principally for DVT/PE using the International Classification of Diseases (ICD)-10 codes. We excluded elective and traumatic readmissions. 30-day readmission was calculated as the percentage of patients readmitted within 30 days over index hospitalizations that were discharged alive. Using a "rank" command in STATA, the most common reasons for readmission were outlined. Logistic regression was used to compare inpatient mortality between readmissions and index hospitalizations. STATA, 16 was used for analysis. Since NRD contains de-identified patient data, Institutional Review Board (IRB) review was not sought. Results: A total of 2339 index hospitalizations for DVT/PE among pancreatic cancer patients were discharged alive. Among these, 510 (21.8%) were readmitted within 30 days. The top 5 reasons for 30-day readmissions were sepsis, pancreatic cancer, PE without cor pulmonale, metastatic cancer of the liver and intra-hepatic duct, and pneumonia. 30-day readmissions were responsible for an aggregate of 5.9 million U.S dollars in hospital costs and 2443 hospital days in 2018. Compared to index hospitalizations, 30-day readmissions had higher inpatient mortality (13.4% vs 5.9%, p < 0.0001). Conclusions: 30-day readmissions for DVT/PE in patients with pancreatic cancer have a significant healthcare economic burden. PE, Pancreatic cancer, and infections were common reasons for readmissions. Readmissions have significantly greater inpatient mortality compared to index admissions. Adequate management of DVT/PE and underlying malignancy during index admissions and ensuring timely outpatient follow-up are important in reducing 30-day readmissions of these patients.