Predictors of early hospital readmission after acute pulmonary embolism.
BACKGROUND
Risk factors for early mortality after pulmonary embolism (PE) are widely known. However, it is uncertain which factors are associated with early readmission after PE. We sought to identify predictors of readmission after an admission for PE.


METHODS
We studied 14 426 patient discharges with a primary diagnosis of PE from 186 acute care hospitals in Pennsylvania from January 1, 2000, to November 30, 2002. The outcome was readmission within 30 days of presentation for PE. We used a discrete proportional odds model to study the association between time to readmission and patient factors (age, sex, race, insurance, discharge status, and severity of illness), thrombolysis, and hospital characteristics (region, teaching status, and number of beds).


RESULTS
Overall, 2064 patient discharges (14.3%) resulted in a readmission within 30 days of presentation for PE. The most common reasons for readmission were venous thromboembolism (21.9%), cancer (10.8%), pneumonia (5.2%), and bleeding (5.0%). In multivariable analysis, African American race (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.02-1.38), Medicaid insurance (OR, 1.54; 95% CI, 1.31-1.81), discharge home with supplemental care (OR, 1.40; 95% CI, 1.27-1.54), leaving the hospital against medical advice (OR, 2.84; 95% CI, 1.80-4.48), and severity of illness were independently associated with readmission; readmission also varied by hospital region.


CONCLUSIONS
Early readmission after PE is common. African American race, Medicaid insurance, severity of illness, discharge status, and hospital region are significantly associated with readmission. The high readmission rates for venous thromboembolism and bleeding suggest that readmission may be linked to suboptimal quality of care in the management of PE.
Aujesky
Drahomir
D
Service de Médecine Interne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. drahomir.aujesky@chuv.ch
Mor
Maria K
MK
Geng
Ming
M
Stone
Roslyn A
RA
Fine
Michael J
MJ
Ibrahim
Said A
SA
D000208:Acute Disease; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D002637:Chest Pain / Q000453:epidemiology; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D010349:Patient Compliance / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010414:Pennsylvania / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000453:epidemiology*; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States; D054556:Venous Thromboembolism / Q000453:epidemiology; D001741:Black or African American