Healthcare Resource Utilization and Outcomes in Intermediate-risk Pulmonary Embolism in the United States.

Abstract

Patients with intermediate-risk pulmonary embolism (PE) often experience extended hospitalizations and varied outcomes depending on the treatment modality. This study compares outcomes and healthcare resource utilization among patients treated with anticoagulation (AC), catheter-directed thrombolysis (CDL), other mechanical thrombectomy (MT), or computer-assisted vacuum thrombectomy (CAVT) in the U.S. Adult inpatients with intermediate-risk PE discharged between 07/01/2020 and 09/30/2023 were retrospectively identified from the Vizient Clinical Data Base. ICD-10 codes identified treatment modalities. Propensity score matching (PSM) equated groups 1:1 using demographics, payer and hospital type. Outcomes included length of stay (LOS), post-procedure LOS (PPLOS), post-procedure intensive care unit days (PPICU), in-hospital mortality, composite complications, discharge status, and readmission rates. PSM matched 515 patients across groups. Baseline data were similar. CAVT had shorter LOS (4.6±3.23d) than AC (6.2±3.72d, P<0.0001), CDL (7.1±4.42d, P<0.0001), and MT (7.0±4.62d, P<0.0001). CAVT had shorter PPLOS (3.8±3.16d) than CDL (6.1±4.33d, P<0.0001) and MT (6.2±4.52d, P<0.0001). CAVT had fewer and shorter PPICU stays than CDL (44.3% vs 82.7%, P <0.0001; 0.7±1.3d vs 1.6±1.5d, P<0.0001). CAVT showed lower composite complications than MT (1.2% vs. 4.1%, P=0.0034), and lower incidence of acute kidney injury development during hospitalization than MT (1.9% vs. 4.9%, P=0.0099) and CDL (1.9% vs. 4.5%, P=0.0214). In-hospital mortality, 30-day all-cause and PE-related readmissions were similar. CAVT had a higher rate of discharge-to-home (69%) than AC (55.5%, P<0.0001), CDL (56.3%, P<0.0001) and MT (52.6%, P<0.0001). In conclusion, CAVT for intermediate-risk PE may shorten LOS, PPLOS, reduce complications, and improve discharge outcomes without increasing mortality compared to other treatment modalities.