TY - JOUR
T1 - Analysis of National Trends in Admissions for Pulmonary Embolism
AU - Smith, Sean B.
AU - Geske, Jeffrey B.
AU - Kathuria, Parul
AU - Cuttica, Michael
AU - Schimmel, Daniel R.
AU - Courtney, D. Mark
AU - Waterer, Grant W.
AU - Wunderink, Richard G.
N1 - Publisher Copyright:
© 2016 American College of Chest Physicians
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background Pulmonary embolism (PE) remains a significant cause of hospital admission and health-care costs. Estimates of PE incidence came from the 1990s, and data are limited to describe trends in hospital admissions for PE over the past decade. Methods We analyzed Nationwide Inpatient Sample data from 1993 to 2012 to identify patients admitted with PE. We included admissions with International Classification of Diseases, 9th revision, codes listing PE as the principal diagnosis as well as admissions with PE listed secondary to principal diagnoses of respiratory failure or DVT. Massive PE was defined by mechanical ventilation, vasopressors, or nonseptic shock. Outcomes included hospital lengths of stay, 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 <.001). The percent of admissions meeting criteria for massive PE decreased (5.3% to 4.4%, P =.002), but the absolute number of admissions for massive PE increased (from 1.5 to 2.8 per 100,000, P <.001). Median length of stay decreased from 8 (interquartile range [IQR], 6-11) to 4 (IQR, 3-6) days (P <.001). Adjusted hospital charges increased from $16,475 (IQR, $10,748-$26,211) in 1993 to $25,728 (IQR, $15,505-$44,493) in 2012 (P <.001). All-cause hospital mortality decreased from 7.1% to 3.2% (P <.001), but population-adjusted deaths during admission for PE increased from 1.6 to 2.1 per 100,000 (P <.001). Conclusions Total admissions and hospital charges for PE have increased over the past 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 toward more admissions of less severe PE.
AB - Background Pulmonary embolism (PE) remains a significant cause of hospital admission and health-care costs. Estimates of PE incidence came from the 1990s, and data are limited to describe trends in hospital admissions for PE over the past decade. Methods We analyzed Nationwide Inpatient Sample data from 1993 to 2012 to identify patients admitted with PE. We included admissions with International Classification of Diseases, 9th revision, codes listing PE as the principal diagnosis as well as admissions with PE listed secondary to principal diagnoses of respiratory failure or DVT. Massive PE was defined by mechanical ventilation, vasopressors, or nonseptic shock. Outcomes included hospital lengths of stay, 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 <.001). The percent of admissions meeting criteria for massive PE decreased (5.3% to 4.4%, P =.002), but the absolute number of admissions for massive PE increased (from 1.5 to 2.8 per 100,000, P <.001). Median length of stay decreased from 8 (interquartile range [IQR], 6-11) to 4 (IQR, 3-6) days (P <.001). Adjusted hospital charges increased from $16,475 (IQR, $10,748-$26,211) in 1993 to $25,728 (IQR, $15,505-$44,493) in 2012 (P <.001). All-cause hospital mortality decreased from 7.1% to 3.2% (P <.001), but population-adjusted deaths during admission for PE increased from 1.6 to 2.1 per 100,000 (P <.001). Conclusions Total admissions and hospital charges for PE have increased over the past 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 toward more admissions of less severe PE.
KW - hospitalization
KW - mortality
KW - pulmonary embolism
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U2 - 10.1016/j.chest.2016.02.638
DO - 10.1016/j.chest.2016.02.638
M3 - Article
C2 - 26905364
AN - SCOPUS:84990041933
VL - 150
SP - 35
EP - 45
JO - Diseases of the chest
JF - Diseases of the chest
SN - 0012-3692
IS - 1
ER -