Background: Pulmonary embolism (PE) is a frequent cause of hospitalization. It results in significant mortality and morbidity. Several studies have examined the mortality associated with PE and improvements seen with different modalities of treatment. However, other outcomes of PE hospitalization such as length of stay and ICU utilization have not been well-examined. The objective of this study is to examine outcomes associated with PE in a comprehensive manner.
Methods: A large national database, Vizient database, was utilized for the study. The database was accessed using ICD-10 codes for patients admitted with a principal diagnosis of pulmonary embolism with or without cor pulmonale. Data from 2015-2017 was included in the study. Outcome variables analyzed include mortality, length of stay, direct costs, ICU admission. In addition, gender, race and age differences in outcomes were also examined.
Results: 67,180 patients were included in the study. Overall observed mortality in these patients was 3.50% and the ICU utilization was required in 19.50% of these patients. Mean length of stay was 4.76 days. Analysis of outcomes by gender indicates that women have a significantly longer length of stay (4.64 ± 5.39 days in male vs 4.87 ± 5.71 days in female; p<0.0001) but lower ICU admission (20.13% in male vs 18.64% in female; p<0.0001). No significant gender differences in costs and mortality were found. As age increases, higher mortality (1.90% in 18-30 years vs 4.88% in >51 years group; p<0.0001) and length of stay (4.34 ± 5.70 days in 18-30 years age group vs 5.14 ± 4.94 days in >51 years age group; p<0.0001) is noted in the older age groups. Direct costs ($ 6775) and ICU admission (20.51%) however were highest in the 31-50 year age group. Analysis of outcomes by race showed significant racial differences. Asians with PE showed significantly worse outcomes with respect to costs ($ 7769 ± 15,918 in Asians vs $ 6173 ± 9362 in Caucasians; p<0.0001) and length of stay (5.05 ± 7.67 days in Asians vs 4.51 ± 4.84 days in Caucasians; p<0.0001). Mortality was highest in Asians (4.68% in Asians vs 3.31% in Caucasians) but not statistically different. ICU admission was higher in African-Americans (19.80% in African-Americans vs 18.98% in Caucasians) but not significantly different.
Conclusions: This study is a comprehensive examination of the outcomes of pulmonary embolism. Women showed slightly worse outcomes. As age increased, worse outcomes were noted in the older age groups. Significant racial differences were also seen with Asians having worst outcomes.