Pulmonary Embolism Readmission Trend Over the Years (from a National Readmission Database)

With the evolution of pulmonary embolism (PE) management, the outcomes of PE-related complications and the need for readmission have not been well studied. The aim of this study is to see the trend in readmissions in patients with PE from 2010 to 2018. We used the National Readmission Database from 2010 to 2018 to identify hospitalized patients with a principal diagnosis of acute PE. We then identified the total number of readmissions for acute PE from 2010 to 2018. These were further stratified based on readmission within 30 days and readmission within 90 days. A multivariate Cox regression model was used to adjust for confounding factors. The 30-day all-cause readmission after principal admission for PE decreased from 11.2% to 9.7% from 2010 to 2014 but increased to 11.8% in 2018 (p <0.001). A similar trend was seen in 90-day readmission. Risk-adjusted readmission specific for PE showed a decrease from 1.2% to 1% (p = 0.004) in the 30-day cohort and from 1.4% to 1.2% (p = 0.006) in the 90-day cohort from 2010 to 2018. When adjusted to age and gender, an increase in the proportion of readmissions with intracranial bleeding was seen among both the 30-day (0.7% in 2010 to 1.2% in 2018, adjusted odds ratio [aOR] 1.06, p = 0.006) and 90-day (0.7% in 2010 to 1.2% in 2018, aOR 1.06, p-trend = 0.003) cohorts. Similarly, an increasing trend of readmissions for upper gastrointestinal bleed was seen among both 30-day (0.9% vs 4.3%, aOR 1.26, p-trend <0.001) and 90-day (0.7% vs 3.8%, aOR 1.27, p-trend <0.001) readmissions. Our study suggests that there is a statistically significant decrease in PE-specific readmission from 2010 to 2018 but a variable trend in all-cause readmissions. We also report an increase in bleeding during readmissions, including intracranial hemorrhage and upper gastrointestinal bleed. In conclusion, these findings warrant further studies to elucidate the mechanism for decreasing PE-specific readmission and possible causes for the increase in all-cause readmissions.