Hospitalizations during the 30-day period preceding admission with pulmonary embolism: insights from the national readmission database

OBJECTIVES: We aim to determine the frequency and causes of hospitalizations prior to an admission with a diagnosis of pulmonary embolism (PE).

METHODS: We conducted a retrospective cohort study using the United States National Readmission Database (NRD) from 2018 to 2020 to evaluate hospitalizations with a primary diagnosis of PE and in-hospital outcomes. We identified the number and causes of hospital admissions occurring within the 30 days preceding the PE hospitalization. Factors associated with prior hospitalization and in-hospital mortality during PE admission were examined. This analysis describes the characteristics of PE patients with prior hospitalization but does not assess risk.

RESULTS: A total of 2,651,870 hospital admissions for PE were included in the analysis, of which 16.3% (n = 431,700) had a prior hospitalization within the preceding 30 days. The most common reason for prior admission was sepsis (10.9%). Other notable but less frequent causes included orthopedic conditions associated with reduced mobility, cancer, and cardiovascular diseases. The strongest predictor of prior hospitalization was elective admission (OR 2.89, 95% CI 2.82-2.95). Additional factors associated with increased odds of prior hospitalization included cancer (OR 1.60, 95% CI 1.57-1.63), prior myocardial infarction (OR 1.24, 95% CI 1.20-1.28), and diabetes mellitus (OR 1.19, 95% CI 1.17-1.21). Prior hospitalization was associated with increased odds of in-hospital mortality during the PE admission (OR 1.95, 95% CI 1.89-2.00).

CONCLUSIONS: Approximately one in six patients admitted with PE had a hospitalization in the preceding 30 days, and these patients experienced higher in-hospital mortality. Common reasons for prior admissions included sepsis, orthopedic conditions related to immobility, cancer, and cardiovascular disease.