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Analysis of National Trends in Admissions for Pulmonary Embolism.
Chest. 2016 Feb 18;
Authors: Smith SB, Geske JB, Kathuria P, Cuttica M, Schimmel DR, Courtney DM, Waterer GW, Wunderink RG
Abstract
BACKGROUND: Pulmonary embolism (PE) remains a significant cause of hospital admission and healthcare costs. Estimates of PE incidence came from the 1990s, and data are limited to describe trends in hospital admissions for PE over the last decade.
METHODS: We analyzed Nationwide Inpatient Sample (NIS) data from 1993 to 2012 to identify patients admitted with PE. We included admissions with ICD-9 codes listing PE as the principal diagnosis as well as admissions with PE listed secondary to principal diagnoses of respiratory failure or deep vein thrombosis. Massive PE was defined by mechanical ventilation, vasopressors, or non-septic shock. Outcomes included hospital lengths-of-stay (LOS), adjusted charges, and all-cause hospital mortality. Linear regression was used to analyze changes over time.
RESULTS: Admissions for PE increased from 23 per 100,000 in 1993 to 65 per 100,000 in 2012 (p<0.001). The percent of admissions meeting criteria for massive PE decreased (5.3% to 4.4%, p=0.002), but the absolute number of admissions for massive PE increased (1.5 to 2.8 per 100,000, p<0.001). Median LOS decreased from 8 (IQR 6 - 11) to 4 (3 - 6) days (p<0.001). Adjusted hospital charges increased from $16,475 (IQR $10,748 - $26,211) in 1993 to $25,728 ($15,505 - $44,493) in 2012 (p<0.001). All-cause hospital mortality decreased from 7.1% to 3.2% (p<0.001), but population-adjusted deaths during admission for PE increased from 1.6 to 2.1 per 100,000 (p<0.001).
CONCLUSIONS: Total admissions and hospital charges for PE have increased over the last two decades. However, the population-adjusted admission rate has increased disproportionately to the incidence of patients with severe PE. We hypothesize that these findings reflect a concerning national movement towards more admissions of less severe PE.
PMID: 26905364 [PubMed - as supplied by publisher]