Background: International VTE management guidelines recommend outpatient management for appropriate patients with low-risk deep vein thrombosis (DVT) or pulmonary embolism (PE)[1-3]. Despite the evidence and recommendations, previous studies reported low prevalence of outpatient management, especially for PE[4, 5]. This analysis aimed to characterize trends in outpatient vs. inpatient management of VTE in the last 5 years and to compare readmission rates based on discharge disposition type.
Methods: Patients 18 years or older with a hospital urgent/emergent encounter for a primary discharge International Classification of Diseases (ICD-10) diagnosis code of VTE between Jan. 2016 and Dec. 2020 were identified from a large national hospital database (Premier Healthcare Database). All VTE encounters presented in the emergency department (ED) and were categorized based on initial ED discharge disposition type (home, observation, inpatient). The proportion of each discharge disposition type was calculated for all VTE encounters and primary diagnosis of DVT and PE. All-cause and VTE-related readmissions (defined as an urgent or emergent inpatient admission or ED visit) occurring within 1 to 30 days after the index VTE encounter discharge date were evaluated for all VTE encounters and stratified by discharge disposition type and VTE type.
Results: Of the 437,277 VTE encounters, 41% (n=180,554; mean age: 61; males: 43%) were classified as DVT, while 59% (n=256,673; mean age: 61; males: 57%) were classified as PE. Of all the encounters included, for DVT and PE respectively, 46% (n=83,529) and 7% (n=18,528) were discharged home from the emergency department, 46% (n=82,528) and 84% (n=215,275) were moved to inpatient/transferred acutely, and 8% and 9% were discharged to observation unit and then home. Figure 1 shows the percentage for each discharge disposition type trended year-over-year. 18% (n=77,555) of VTE encounters had an all-cause readmission encounter, while 3% (n=13,009) of VTE encounters had a VTE-related readmission encounter. Comparison of all-cause and VTE-related readmission rates stratified by discharge disposition type for DVT and PE patients are reported in Figure 2.
Conclusions: A positive year-over-year trend towards outpatient management was observed for DVT and PE. While almost half of DVT patients were discharged home from the ED, the proportion of those with PE managed on an outpatient basis remained low, which is consistent with previous studies. Readmission rates were numerically similar for outpatient vs. inpatient management in DVT, but there was a notable higher readmission rate in PE patients managed in outpatient, requiring further investigation, especially as our analysis did not assess PE and DVT severity to determine patient eligibility for outpatient management.
