Abstract 16110: Impact of Institutional Volume on In-hospital Mortality and Resource Utilization Among Patients With Pulmonary Embolism Treated With Catheter Directed Thrombolysis: A Population-Based Cohort Study

Introduction: Catheter-directed thrombolysis (CDT) is an evolving percutaneous approach for the management of acute pulmonary embolism (PE). Contemporary data examining in-hospital outcomes in relation to procedural volume are limited. Methods: Data sets were extracted from the 2016 national readmission database. Using ICD 10 codes, a search was performed to identify all patients hospitalized with a primary or secondary diagnosis of PE who underwent CDT between 1/1/2016 and 12/31/2016. Hospitals were grouped into quartiles by CDT volume and rates of in-hospital mortality, length of stay, and cost were compared across groups. Adjusted associations were examined using multivariable logistic regression. Results and Conclusions: We identified 2,353 unique patients with PE who underwent CDT at 483 hospitals. The median (25th, 75th percentiles) number of CDT procedures per hospital was 3 (1, 6). Mortality rates were 11.4%, 5.3%, 5.6% and 3.8%, respectively, at hospitals in the 1st, 2nd, 3rd and 4th quartile of CDT procedural volume (Figure; p=0.001). Results were unchanged after multivariable adjustment. Median length of stay by quartile was as follows: 6.5, 5, 5, and 4 days (p <0.001). The median cost for the different quartiles was $28,277, $25,953, $25,896, and $23,007 (p <0.001). We found that CDT performed in patients with PE at low-volume hospitals is associated with excess mortality as well as increased length of stay and cost when compared with higher-volume centers. These findings may inform guidance for volume thresholds for utilization of CDT in the management of acute PE.

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In-Hospital Mortality and Related Outcomes for Elevated Risk Acute Pulmonary Embolism Treated With Mechanical Thrombectomy Versus Routine Care

Journal of Intensive Care Medicine ◽

10.1177/08850666211036446 ◽

2021 ◽

pp. 088506662110364

Author(s):

Jennifer R. Buckley ◽

Brandt C. Wible

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Length Of Stay ◽

Hospital Mortality ◽

Routine Care ◽

Hospital Length ◽

Elevated Risk ◽

Hospital Length Of Stay ◽

Icu Length Of Stay

Purpose To compare in-hospital mortality and other hospitalization related outcomes of elevated risk patients (Pulmonary Embolism Severity Index [PESI] score of 4 or 5, and, European Society of Cardiology [ESC] classification of intermediate-high or high risk) with acute central pulmonary embolism (PE) treated with mechanical thrombectomy (MT) using the Inari FlowTriever device versus those treated with routine care (RC). Materials and Methods Retrospective data was collected of all patients with acute, central PE treated at a single institution over 2 concurrent 18-month periods. All collected patients were risk stratified using the PESI and ESC Guidelines. The comparison was made between patients with acute PE with PESI scores of 4 or 5, and, ESC classification of intermediate-high or high risk based on treatment type: MT and RC. The primary endpoint evaluated was in-hospital mortality. Secondary endpoints included intensive care unit (ICU) length of stay, total hospital length of stay, and 30-day readmission. Results Fifty-eight patients met inclusion criteria, 28 in the MT group and 30 in the RC group. Most RC patients were treated with systemic anticoagulation alone (24 of 30). In-hospital mortality was significantly lower for the MT group than for the RC group (3.6% vs 23.3%, P < .05), as was the average ICU length of stay (2.1 ± 1.2 vs 6.1 ± 8.6 days, P < .05). Total hospital length of stay and 30-day readmission rates were similar between MT and RC groups. Conclusion Initial retrospective comparison suggests MT can improve in-hospital mortality and decrease ICU length of stay for patients with acute, central PE of elevated risk (PESI 4 or 5, and, ESC intermediate-high or high risk).

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P2769Racial differences in outcomes among acute pulmonary embolism patients: a nationwide analysis

European Heart Journal ◽

10.1093/eurheartj/ehz748.1086 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Shi

Keyword(s):

Pulmonary Embolism ◽

Regression Analysis ◽

Length Of Stay ◽

Hospital Mortality ◽

Acute Pulmonary Embolism ◽

Primary Diagnosis ◽

Total Cost ◽

Rehabilitation Facilities ◽

The Impact ◽

White Patients

Abstract Background Limited data is available regarding racial disparities in patients admitted for acute pulmonary embolism. Purpose We aimed to examine the impact of racial differences on outcomes in patients admitted for acute pulmonary embolism. Methods We used the Nationwide Inpatient Sample, which represents 20% of community hospital discharges in the US, to identify adult patients who were discharged with the primary diagnosis of acute pulmonary embolism in 2016 with ICD-10 codes. Logistic regression analysis and linear regression analysis were used to compare patients with different races. Outcomes were focused on in-hospital mortality, total cost, length of stay and disposition, adjusting gender, age, Charlson comorbid index and socioeconomic variables. Results In 2016, 35,526 patients were admitted with a primary diagnosis of acute pulmonary embolism. White patients were more likely to be older and with higher income. After adjusting for the above variables, white patients had lower total cost of hospitalization (p<0.0001), shorter length of stay (p<0.0001), lower in-hospital mortality (adjusted odds ratio = 0.79, p=0.001), and more likely to be discharged to rehabilitation facilities compared to being discharged home. Outcomes in white vs non-white patients Conclusion Among acute pulmonary embolism hospitalizations, white patients generally had better outcomes despite being older in age, and were more likely to be transferred to rehabilitation facilities after discharge.

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Comprehensive analysis of in-hospital delirium after major surgical oncology procedures

Canadian Urological Association Journal ◽

10.5489/cuaj.6030 ◽

2019 ◽

Vol 14 (3) ◽

Author(s):

Marco Bandini ◽

Michele Marchioni ◽

Felix Preisser ◽

Sebastiano Nazzani ◽

Zhe Tian ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Hospital Mortality ◽

Lung Resection ◽

Temporal Trends ◽

Surgical Oncology ◽

Population Based ◽

Hospital Charges ◽

Weighted Estimate ◽

Prolonged Length

Introduction: Very few population-based assessments of delirium have been performed to date. These have not assessed the implications of delirium after major surgical oncology procedures (MSOPs). We examined the temporal trends of delirium following 10 MSOPs, as well as patient and hospital delirium risk factors. Finally, we examined the effect of delirium on length of stay, in-hospital mortality, and hospital charges. Methods: We retrospectively identified patients who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection, or pancreatectomy within the Nationwide Inpatient Sample (2003‒2013). We yielded a weighted estimate of 3 431 632 patients. Multivariable logistic regression (MLR) analyses identified the determinants of postoperative delirium, as well as the effect of delirium on length of stay, in-hospital mortality, and hospital charges. Results: Between 2003 and 2013, annual delirium rate increased from 0.7 to 1.2% (+6.0%; p<0.001). Delirium rates were highest after cystectomy (predicted probability [PP] 3.1%) and pancreatectomy (PP 2.6%) and lowest after prostatectomy (PP 0.15%) and mastectomy (PP 0.13%). Advanced age (odds ratio [OR] 3.80), maleness (OR 1.38), and higher Charlson comorbidity index (OR 1.20), as well as postoperative complications represent risk factors for delirium after MSOPs. Delirium after MSOP was associated with prolonged length of stay (OR 3.00), higher mortality (OR 1.15) and increased in-hospital charges (OR 1.13). Conclusions: No contemporary population-based assessments of delirium after MSOP have been reported. According to our findings, delirium after MSOP has a profound impact on patient outcomes that ranges from prolonged length of stay to higher mortality and increased in-hospital charges.

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Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort study

BMC Health Services Research ◽

10.1186/s12913-021-07318-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Claudia Dziegielewski ◽

Robert Talarico ◽

Haris Imsirovic ◽

Danial Qureshi ◽

Yasmeen Choudhri ◽

...

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Healthcare Costs ◽

Healthcare Expenditure ◽

Healthcare Spending ◽

Population Based ◽

Icu Length Of Stay

Abstract Background Healthcare expenditure within the intensive care unit (ICU) is costly. A cost reduction strategy may be to target patients accounting for a disproportionate amount of healthcare spending, or high-cost users. This study aims to describe high-cost users in the ICU, including health outcomes and cost patterns. Methods We conducted a population-based retrospective cohort study of patients with ICU admissions in Ontario from 2011 to 2018. Patients with total healthcare costs in the year following ICU admission (including the admission itself) in the upper 10th percentile were defined as high-cost users. We compared characteristics and outcomes including length of stay, mortality, disposition, and costs between groups. Results Among 370,061 patients included, 37,006 were high-cost users. High-cost users were 64.2 years old, 58.3% male, and had more comorbidities (41.2% had ≥3) when likened to non-high cost users (66.1 years old, 57.2% male, 27.9% had ≥3 comorbidities). ICU length of stay was four times greater for high-cost users compared to non-high cost users (22.4 days, 95% confidence interval [CI] 22.0–22.7 days vs. 5.56 days, 95% CI 5.54–5.57 days). High-cost users had lower in-hospital mortality (10.0% vs.14.2%), but increased dispositioning outside of home (77.4% vs. 42.2%) compared to non-high-cost users. Total healthcare costs were five-fold higher for high-cost users ($238,231, 95% CI $237,020–$239,442) compared to non-high-cost users ($45,155, 95% CI $45,046–$45,264). High-cost users accounted for 37.0% of total healthcare costs. Conclusion High-cost users have increased length of stay, lower in-hospital mortality, and higher total healthcare costs when compared to non-high-cost users. Further studies into cost patterns and predictors of high-cost users are necessary to identify methods of decreasing healthcare expenditure.

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Comparison of Effectiveness between Anticoagulation and Thrombolysis Therapy for Pulmonary Embolism in Patients Complicated with Shock: A Nationwide Population-Based Study

Thrombosis and Haemostasis ◽

10.1055/s-0040-1713095 ◽

2020 ◽

Vol 120 (08) ◽

pp. 1208-1216

Author(s):

Jen-Kuang Lee ◽

Wen-Hsin Chen ◽

Yu-Sheng Lin ◽

Chih-Hsiang Chang ◽

Tien-Hsing Chen

Keyword(s):

Pulmonary Embolism ◽

Thrombolytic Therapy ◽

Hospital Mortality ◽

Anticoagulation Therapy ◽

Bleeding Risk ◽

Population Based ◽

Secondary Outcome ◽

Research Database ◽

Similar Treatment ◽

Comparison Of Effectiveness

Abstract Objective This study aimed to compare the efficacy of anticoagulation therapy and thrombolytic therapy for pulmonary embolism (PE) in patients complicated with shock. Methods This retrospective cohort study used administrative data from Taiwan's National Health Insurance Research Database. Patients admitted due to PE who received inotropic support between January 1, 1997, and December 31, 2011, were included. To closely mimic a randomized experiment, anticoagulation and thrombolysis plus anticoagulation groups were subjected to propensity score matching (PSM) according to demographic characteristics, comorbidities, and inotropic agent dosage. The primary outcome was in-hospital mortality. The secondary outcome was 3-month mortality after discharge. Results After PSM, a total of 820 patients, including 164 thrombolysis and 656 anticoagulation patients, were enrolled. The in-hospital mortality was 48.2% in the thrombolysis group and 52.4% in the anticoagulation group (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.59–1.18). Major bleeding occurred in 19 (11.6%) of the thrombolysis patients and 57 (8.7%) of the anticoagulation patients (OR 1.37, 95% CI, 0.79–2.38). The 90-day mortality rates in the thrombolysis and anticoagulation groups were 15.3% (13 patients) and 17.6% (55 patients), respectively; this difference was not significant (hazard ratio 0.88, 95% CI 0.48–1.61). Conclusion In PE patients complicated with shock, anticoagulation therapy provides similar treatment efficacy to thrombolytic therapy in terms of in-hospital and 90-day mortality. The bleeding risk was also similar in the two treatment groups.

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Hospital safety among neurologic patients

Neurology ◽

10.1212/wnl.0000000000004111 ◽

2017 ◽

Vol 89 (3) ◽

pp. 284-290 ◽

Cited By ~ 5

Author(s):

Khara M. Sauro ◽

Hude Quan ◽

Khokan C. Sikdar ◽

Peter Faris ◽

Nathalie Jette

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Length Of Stay ◽

Population Based ◽

Quality And Safety ◽

Respiratory Complications ◽

Hospital Safety ◽

Cord Injury ◽

Icd 10 ◽

Abstract Data

Objective:To examine the frequency and type of adverse events (AEs) experienced by neurologic patients in hospital.Methods:This population-based, retrospective cohort study used hospital discharge abstract data for children and adults admitted to hospital from 2009 to 2015 with 1 of 9 neurologic conditions (Alzheimer disease and related dementia, brain tumor, epilepsy, motor neuron disease, multiple sclerosis, parkinsonism/Parkinson disease, spinal cord injury, traumatic brain injury, and stroke). Neurologic conditions were identified with ICD-10-CA codes. Eighteen AEs were examined with ICD-10-CA codes. The proportion of AEs was calculated, and regression analysis was used to examine factors and outcomes associated with AEs (age, sex, comorbidity, length of stay, and mortality).Results:The overall proportion of admissions associated with an AE among those with a neurologic condition was 11 per 100 admissions. Those with a spinal cord injury had the highest proportion of AEs (39.4 per 100 admissions). The most common AEs were infections and respiratory complications (32.0% and 16.7%, respectively). Age and the presence of comorbidities were associated with higher odds of an AE, while readmission was associated with lower odds of an AE. Having an AE was associated with increased length of stay and higher odds of mortality.Conclusions:This study demonstrates that neurologic patients have a high proportion of AEs in hospital. The findings provide information on the quality and safety of care for people with neurologic conditions in hospital, which can help inform future quality improvement initiatives.

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Pragmatic Use of Catheter-Directed Thrombolysis in Venous Thromboembolism and a Comparative Evaluation With Traditional Therapies in Submassive Pulmonary Embolism

Journal of Pharmacy Practice ◽

10.1177/08971900211004833 ◽

2021 ◽

pp. 089719002110048

Author(s):

Mary Bradley ◽

Todd Bull ◽

Peter Hountras ◽

Robert MacLaren

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Hospital Mortality ◽

Group Versus ◽

Chart Audit ◽

Systemic Thrombolysis ◽

Ivc Filters ◽

Catheter Directed Thrombolysis ◽

Submassive Pulmonary Embolism ◽

Traditional Therapies

Background: Catheter-directed thrombolysis (CDT) is a novel treatment for venous thromboembolism (VTE). Limited data describe pragmatic use of CDT and compare CDT to other VTE therapies. Objective: Assess the use of CDT and comparatively evaluate CDT, anticoagulation, and systemic thrombolysis in submassive pulmonary embolism (PE). Methods: Retrospective, single-center, chart audit. Part 1 described all patients who received CDT for VTE. Part 2 matched patients with submassive PE who received CDT, heparin, or systemic thrombolysis and assessed length of stay (LOS), bleeding, all cause in-hospital mortality, and escalation of care. Results: For part 1, 70 CDT patients were identified; 42 with DVT and 28 with PE. ICU LOS was longer (2.5 ± 2.9 vs. 4.9 ± 8.4 days, p = 0.07), escalation of care more frequent (0% vs. 35.7%, p < 0.0001), and hospital mortality greater (2.4% vs. 21.4%, p = 0.014) in the PE group. For part 2, 21 CDT patients were matched to 21 heparin and 21 systemic thrombolysis patients. All CDT and tPA patients were admitted to the ICU versus only 6 (28.6%, p < 0.001) heparin patients. ICU LOS was significantly longer in the CDT group versus systemic tPA and systemic anticoagulation (80.7 ± 64.1 vs. 48.2 ± 27.7 vs. 24.9 ± 59.1 hours; p = 0.0048). More IVC filters and thrombectomies were performed in the CDT group. Conclusions: CDT is frequently used for both DVT and PE and requires ICU admission. Escalation of care is common when CDT is used for PE. For submassive PE, CDT is associated with prolonged ICU LOS compared to heparin or systemic thrombolysis. Resource utilization with CDT requires further evaluation.

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Association between anticoagulants and mortality and functional outcomes in older patients with major trauma

Emergency Medicine Journal ◽

10.1136/emermed-2019-209368 ◽

2021 ◽

pp. emermed-2019-209368

Author(s):

Nobuhiro Sato ◽

Peter Cameron ◽

Susan Mclellan ◽

Ben Beck ◽

Belinda Gabbe

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Functional Outcomes ◽

Major Trauma ◽

Unit Length ◽

Antiplatelet Agents ◽

Population Based ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Antiplatelet Medication

BackgroundThe number of trauma patients taking anticoagulants and antiplatelet agents is increasing as society ages. However, there have been limited and inconsistent reports of the association between anticoagulants and mortality and functional outcomes. This study aimed to quantify the association between anticoagulant/antiplatelet medication at the time of injury and both short-term and longer-term outcomes in older major trauma patients.MethodsThis was a population-based registry study using data from the Victorian State Trauma Registry from July 2017 to June 2018. We included patients with major trauma aged 65 years and older. The outcomes of interest were in-hospital mortality, hospital length of stay, intensive care unit length of stay and the Extended Glasgow Outcome Scale (GOS-E) at 6 months after injury. We examined the association between the outcomes and anticoagulants/antiplatelet agents at the time of injury and used multivariable logistic regression models to account for known confounders.ResultsThere were 1323 older adults eligible for inclusion in the study, of which 249 (18.8%) were taking anticoagulants (n=8 were taking both anticoagulants and antiplatelet agents), 380 (28.7%) were taking antiplatelet agents and 694 (52.5%) were not using either. Any anticoagulant use was associated with higher odds of in-hospital mortality (adjusted OR (AOR), 2.38; 95% CI 1.58 to 3.59) compared with not using anticoagulants. No differences were observed in the GOS-E at 6 months after injury between any anticoagulants use, antiplatelet use and no anticoagulant use (anticoagulant AOR, 0.71; 95% CI 0.48 to 1.05, antiplatelet AOR, 1.02; 95% CI 0.73 to 1.42).ConclusionAnticoagulant use at the time of injury was associated with higher odds of in-hospital mortality but did not adversely impact functional outcomes at 6 months after injury. These findings demonstrate the importance of seeking an accurate history of anticoagulant use and its indication, as well as the immediate initiation of reversal therapies.

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Prevalence of Pulmonary Embolism Among Patients with Acute Exacerbations of Chronic Obstructive Pulmonary: Data from Nationwide Inpatient Sample

Blood ◽

10.1182/blood.v126.23.2076.2076 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2076-2076

Author(s):

Ranjan Pathak ◽

Smith Giri ◽

Paras Karmacharya ◽

Anthony Donato

Keyword(s):

Pulmonary Embolism ◽

Length Of Stay ◽

Hospital Mortality ◽

Nationwide Inpatient Sample ◽

Conflicts Of Interest ◽

Routine Screening ◽

Hospital Charges ◽

National Database ◽

Chronic Obstructive ◽

Presenting Symptoms

Abstract Background Patients suffering from acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are thought to be at a higher risk of developing venous thromboembolism due to various reasons such as smoking, immobilization and a transient procoagulant state. However, clinical diagnosis of acute pulmonary embolism (PE) in patients with AECOPD is often difficult due to the similarity in the presenting symptoms of the two conditions. Literature regarding the true prevalence of PE among patients with AECOPD and the role of routine screening for PE in these patients with imaging is controversial. Although some studies have suggested prevalence rates to be as high as 20-25%, thus justifying a routine CT pulmonary angiography (CTPA) to evaluate for PE in these patients, other studies have refuted such findings. Methods We used the 2011 Nationwide Inpatient Sample database to identify patients aged ≥18 years admitted with AECOPD (International Classification of Diseases, 9th Revision, Clinical-Modification [ICD-9-CM] code 491.21). Patients with AECOPD with co-existing PE were identified using the ICD-9-CM codes 415.1x and 673.2x. Prevalence of PE in patients with AECOPD was calculated. Similarly, in-hospital mortality, length of stay and mean hospital charge was derived for patient with AECOPD, with and without PE. Statistical analysis was performed using Stata 13.1 (STATA Corp, College Station, TX), which accounted for the complex survey design and clustering of the database. Results A total of 1,187,808 admissions with AECOPD were identified, of which 1.18% (n=13,988) patients were found to have co-existent PE. On Univariate analyses, no differences were seen in the demographic characteristics (mean age, sex, race, primary payer, region, bed-size, teaching status) of AECOPD patients with and without PE. However, diagnosis of concurrent PE in patients with AECOPD was associated with higher in-hospital mortality (10.6% vs. 3.81%, p<0.001), mean length of stay (9.38 vs. 5.92 days, p<0.001) and mean total hospital charges ($74,234 vs. 40,424, p<0.001). Conclusion In this study of large national database, we found the prevalence of PE in patients admitted for AECOPD to be much lower than reported in literature, suggesting that routine imaging to rule out PE is unlikely to be cost effective. Furthermore, routine screening of AECOPD patients for PE with CTPA might actually result in more untoward effects such as incidental pulmonary nodules and PEs with further unnecessary testing and treatment. Disclosures No relevant conflicts of interest to declare.

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