Abstract
Introduction: Prolonged hospitalization leads to worse outcomes in patients admitted with acute pulmonary embolism (PE). However, there is a scarcity of data regarding the factors predisposing to prolonged hospitalization in such patients. Hypothesis: We aimed to identify the factors associated with the prolonged hospitalization and in-hospital mortality among patients admitted with acute PE. Methods: We identified all adults admitted with the primary diagnosis of acute PE from the National Inpatient Sample database (2017). We divided all the admissions into three cohorts based on their hospital length of stay (LOS) — short (sLOS) within 48 hours, medium (mLOS) 3-5 days, and extended (eLOS) >5 days. More than 48 hours of stay was considered prolonged hospitalization. Variables related to patient and hospital-related characteristics were analyzed using logistic regression. Results: A total of 1,87,770 patients (71,215 with sLOS, 72,755 with mLOS, and 43,800 with eLOS) with mean age of 60, 64 and 65 years respectively (p<0.001) were included in the study. Cohorts with mLOS and eLOS had a higher prevalence of females (53% both vs 49%, p<0.001). In multivariate analysis, patients with increasing age, non-white race, tobacco smoking, obesity, associated upper limb and lower limb deep vein thrombosis (DVT), insulin-dependent diabetes, systemic steroids use, recent falls, dementia, and prior chronic respiratory diseases were found to be associated with prolonged hospitalization. Similar factors were also the independent predictors of in-hospital mortality. Interestingly, in-hospital mortality was higher among sLOS (3.8%) and eLOS (4%) compared to mLOS (1.6%). Conclusions: Our study identifies factors independently associated with prolonged hospitalization and in-hospital mortality among patients admitted with acute PE. Knowledge of these factors could aid in treatment strategies and discharge planning.
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