Abstract 9981: Comparison of 30-day Readmission and Healthcare Costs Between Early and Late Catheter Directed Thrombolysis for Acute Pulmonary Embolism in the United States

Abstract

Introduction: Pulmonary embolism (PE) is a major cause of morbidity and mortality accounting for 100,000 deaths per year in the United States and 5-10% of in-hospital deaths. There is sparse comparative data on readmission patterns and healthcare costs in patients who undergo early versus late catheter directed thrombolysis (CDT) for acute PE. Hypothesis: Procedure Day for acute PE may be associated with difference in 30-day readmission rates and healthcare costs. Methods: This study was performed by using National readmission database between January 2016 and November 2019. Patients with acute PE who underwent CDT were identified using the International Classification of Diseases, Tenth Edition (ICD 10) codes. Patients who were <18 years old and patients who underwent thrombolysis for STEMI and Ischemic stroke were excluded. Results: Among a total of 23,564 patients who underwent CDT for acute pulmonary embolism, 12,528 (53.2%) were male and 11034 (46.8%) were female (P=0.014). The mean age of the patients was 60.3 years. The median length of hospital stay was 4 days. Thirty-day readmission rates were higher for patients who underwent CDT on Day 2 or afterwards compared to Day 1 and Day 0 (7.1% vs 5.7% vs 5.2%, for day 2, day 1 and day 0 respectively; p=0.016). Patients who had CDT on Day 2 or more had a higher rate of 30-day readmission mortality compared to those who had CDT on Day 1 or 0 (0.6% vs 0.3% vs 0.2%, for day 2, day 1 and day 0 respectively; Adjusted OR 2.96, 95% CI 1.18 to 7.47 (Ref: day 0), p = 0.021). Thirty-day readmission for heart failure was higher among patients who had CDT on Day 2 vs those who had CDT on Day 0 of admission (2% vs 1.0% vs 0.9%, for day 2, day 1 and day 0 respectively; Adjusted OR 1.97, 95% CI 1.24 to 3.13 (Ref: day 0), p=0.004). Total 30-day costs for patients who underwent CDT on day 2 or more was higher in patients with CDT on day 2 ($55,087; IQR $41,361-$74,092) compared to those with CDT on Day 1 ($45,942; IQR $36,016-$61,211) or Day 0 ($44,814; IQR $34,264-$60,072) (P <0.001). Conclusions: Delayed CDT for acute PE was associated with increased rates of 30-day readmission, readmission mortality, readmission for heart failure and increased healthcare costs. These findings emphasize the need for earlier CDT for the treatment of acute PE.