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Acute pulmonary embolism following recent hospitalization or surgery

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Abstract

Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Recent hospitalization or surgery is a leading risk factor for PE, yet there are minimal data examining its effect on treatment and outcomes. We conducted a retrospective review of institutional billing codes for hospitalized patients with acute PE from August 2012 to August 2018. Patients were stratified based on whether they had a recent major medical encounter (MME), defined as surgery or hospitalization within 90 days. Primary outcomes included in-hospital mortality and 30- and 90-day readmission rates. Secondary outcomes included length of stay (LOS), use of advanced therapies, major bleeding, discharge anticoagulation and recurrent venous thromboembolism (VTE) at 90 days. Outcomes were adjusted for confounders using multivariable regression modeling. 2063 patients were hospitalized for an acute PE; 633 (30.7%) had a recent MME. Patients with a recent MME had a higher average Charlson Comorbidity Index (4.6 vs. 4.0, p < 0.01). Both 30- and 90-day readmission rates were higher in patients with a recent MME (21.7% vs. 14.4%; adjusted OR 1.06 [1.00, 1.12], p = 0.037; 30.8% vs 18.7%; adjusted OR 1.11 [1.11, 1.62], p = 0.003, respectively). After adjustment, there were no between-group differences in in-hospital mortality, LOS, use of advanced therapies, major bleeding, or recurrent VTE at 90 days. In-hospital mortality was higher for patients with a recent medical hospitalization compared to those with a recent surgery (10.2% vs. 5.6%, adjusted OR 1.08 [1.01, 1.15] p = 0.032). Despite recent hospitalization and/or surgery and greater number of comorbidities, patients admitted with a PE and recent MME had similar in-hospital outcomes, but experienced higher readmission rates. In-hospital mortality was higher in those with a recent medical compared to surgical encounter. Clinicians should optimize post-discharge transitional care in this subset of patients.

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References

  1. Chatterjee S, Weinberg I, Yeh RW, Chakraborty A, Sardar P, Weinberg MD, Kabrehl C, Barnes G, Mukherjjee D, Kumbhani D, Bashir R, Vaidya A, Smith A, Fuchs B, Groeneveld P, Giri J (2017) Risk factors for intracranial haemorrhage in patients with pulmonary embolism treated with thrombolytic therapy. Thromb Haemost 117:1–6

    Article  Google Scholar 

  2. Goldhaber SZ, Bounameaux H (2012) Pulmonary embolism and deep vein thrombosis. Lancet 379(9828):1835–1846

    Article  Google Scholar 

  3. Lindblad B, Eriksson A, Bergqvist D (1991) Autopsy-verified pulmonary embolism in a surgical department: analysis of the period from 1951 to 1988. Br J Surg 78:849–852

    Article  CAS  Google Scholar 

  4. Sandler DA, Martin JF (1989) Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med 82:203–205

    Article  CAS  Google Scholar 

  5. Secemsky EA, Rosenfield K, Kennedy KF, Jaff M, Yeh RW (2018) High burden of 30-day readmissions after acute venous thromboembolism in the United States. J Am Heart Assoc 7(13):e009047

    Article  Google Scholar 

  6. Bikdeli B, Want Y, Jimenez D (2019) Pulmonary embolism hospitalization, readmission, and mortality rates in US older adults, 1999–2015. JAMA 322(6):574–576

    Article  Google Scholar 

  7. Keller K, Hobohm L, Ebner M, Kresoja KP, Münzel T, Konstantinides SV, Lankeit M (2020) Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany. Eur Heart J 41(4):522–529

    PubMed  Google Scholar 

  8. Heit JA et al (2000) Risk factors for deep venous thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 160(6):809–815

    Article  CAS  Google Scholar 

  9. Engbers MJ, Blom JW, Cushman M, Rosendaal FR, Van Hylckama VA (2014) The contribution of immobility risk factors to the history of venous thrombosis in an older population. J Thromb Haemost 12:290–296

    Article  CAS  Google Scholar 

  10. Cushman M (2007) Epidemiology and risk factors for venous thrombosis. Semin Hametol 44(2):62–69

    Article  Google Scholar 

  11. Albayati MA, Grover SP, Saha P, Lwaleed BA, Modarai B, Smith A (2015) Postsurgical inflammation as a causative mechanism of venous thromboembolism. Semin Thromb Hemost 41(6):615–620

    Article  Google Scholar 

  12. Beta Clinical Classifications Software (CCS) for ICD-10-CM/PCS n.d. https://www.hcup-us.ahrq.gov/toolssoftware/ccs10/ccs10.jsp Accessed 15 June 2020

  13. Gjonbrataj E, Kim JN, Gjonbrataj J, Jung HI, Kim HJ, Choi WI (2017) Risk factors associated with provoked pulmonary embolism. Korean J Intern Med 32(1):95–101

    Article  Google Scholar 

  14. Uhm JS, Jung HO, Kim CH, Kim TH, Youn HJ, Baek SH, Chung WK, Seung KB (2012) Comparison of clinical and imaging characteristics and outcomes between provoked and unprovoked acute pulmonary embolism in Koreans. J Korean Med Sci 27(11):1347–1353

    Article  CAS  Google Scholar 

  15. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther F, Kahn SR (2012) Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention fo Thrombosis, 9th ed: American College of chest physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl.):e419S

    Article  CAS  Google Scholar 

  16. Farge D, Debourdeau P, Beckers M et al (2013) International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolisn in patients with cancer. J Thromb Haemost 11:56–70

    Article  CAS  Google Scholar 

  17. Ay C, Beyer-Westendorf J, Pabinger I (2019) Treatment of cancer-associated venous thromboembolism in the age of direct oral anticoagulants. Ann Oncol 30(6):897–907

    Article  CAS  Google Scholar 

  18. Kahale LA, Hakoum MB, Tsolakian IG, Matar CF, Terrenato I, Sperati F, Barba M, Yosuico VE, Schünemann H, Aki EA (2018) Anticoagulation for the long-term treatment of venous thromboembolism in people with cancer. Cochrane Database Syst Rev 6(6):CD006650

    PubMed  Google Scholar 

  19. Vedovati MC, Germini F, Agnelli G, Becattini C (2015) Direct oral anticoagulants in patients with VTE and cancer: a systematic review and meta-analysis. Chest 147(2):475

    Article  Google Scholar 

  20. Zhou H, Tang Y, Wang L, Shi C, Feng Y, Yi Q (2016) Risk factors associated with long-term mortality in patients with pulmonary embolism and the predictive value of Charlson Comorbidity Index. Zhonghua Yi Xue Za Zhi 96(4):273–276

    PubMed  Google Scholar 

  21. Van WC, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K, Austin PC, Forster AJ (2010) Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ 182(6):551–557

    Article  Google Scholar 

  22. Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M, Masiukiewicz U, Pak R, Thompson J, Raskob G, Weitz J (2013) Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 369:799–808

    Article  CAS  Google Scholar 

  23. The EINSTEIN Investigators (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 363:2499–2510

    Article  Google Scholar 

  24. Nauffal D, Ballester M, Lopez Reyes R, Jiménez D, Otero R, Quintavalla R, Montreal M, the RIETE INVESTIGATORS (2012) Influence of recent immobilization and recent surgery on mortality in patients with pulmonary embolim. J Thromb Haemost 10:1752–1760

    Article  CAS  Google Scholar 

  25. Kundi H, Wadhera RK, Strom JB, Valsdottir LR, Shen C, Kazi DS, Yeh RW (2019) Association of frailty with 30-day outcomes for acute myocardial infarction, heart failure, and pneumonia among elderly adults. JAMA Cardiol 4(11):1084–1091

    Article  Google Scholar 

  26. McNulty EJ, Ng W, Spertus JA, Zaroff JG, Yeh RW, Ren XM, Lundstrom RJ (2011) Surgical candidacy and selection biases in nonemergent left main stenting: implications for observational studies. JACC Cardiovasc Intervent 4(9):1020–1027

    Article  Google Scholar 

  27. Bradley EH, Curry L, Horwitz LI, Sipsma H, Wang Y, Walsh MN, Goldmann D, White N, Pina IL, Krumholz HM (2013) Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circ Cardiovasc Qual Outcomes 6:444–450

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Internal Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Colby Shanafelt, Rahul Aggarwal, Tyler Mehegan, Abby Pribish, Kevin Soriano & Andrew Dicks

  2. Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Boston, MA, 02215, USA

    Eric A. Secemsky & Brett J. Carroll

  3. Harvard Medical School, Boston, MA, USA

    Eric A. Secemsky & Brett J. Carroll

  4. Department of Medicine, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Rahul Aggarwal, Eric A. Secemsky & Brett J. Carroll

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  1. Colby Shanafelt
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Correspondence to Brett J. Carroll.

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Conflict of interest

Eric A Secemsky: Research grants to BIDMC: AstraZeneca, BD Bard, Boston Scientific, Cook Medical, CSI, Medtronic, Philips, and UCSF. Consultant for BD Bard, CSI, Janssen, Medtronic, and Philips. Speaking Bureau for BD Bard, Cook Medical and Medtronic. Brett J Carroll: Research support from Bristol Meyer Squibb.

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The study was approved by the Institutional Review Board at Beth Israel Deaconess Medical Center.

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Shanafelt, C., Aggarwal, R., Mehegan, T. et al. Acute pulmonary embolism following recent hospitalization or surgery. J Thromb Thrombolysis 52, 189–199 (2021). https://doi.org/10.1007/s11239-020-02322-1

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  • DOI: https://doi.org/10.1007/s11239-020-02322-1

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