Analysis of National Trends in Admissions for Pulmonary Embolism

Abstract

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.

Keywords: hospitalization; mortality; pulmonary embolism.

Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Patients hospitalized for PE from 1993 to 2012. The number of admissions for PE significantly increased; however, the percentage of admissions that met criteria for massive PE decreased. PE = pulmonary embolism.

Figure 2

All-cause hospital mortality for patients hospitalized with PE from 1993 to 2012. The all-cause hospital mortality rate for PE admissions significantly decreased; however, the population-adjusted number of deaths from hospitalizations for PE increased. See Figure 1 legend for expansion of abbreviation.

Figure 3

Hospital length of stay and adjusted charges from 1993 to 2012. Length of stay significantly decreased; however, charges significantly increased.