Analysis of National Trends in Admissions for Pulmonary Embolism
Analysis of National Trends in Admissions for Pulmonary Embolism
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DOI：
10.1016/j.chest.2016.02.638
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发表时间：
2016-07-01
期刊：
影响因子：
9.6
通讯作者：
Wunderink, Richard G.
中科院分区：
文献类型：
--
作者：
Smith, Sean B.;Geske, Jeffrey B.;Wunderink, Richard G.
背景：肺栓塞(PE)仍然是住院和医疗费用的重要原因。对PE发病率的估计来自20世纪90年代，数据仅限于描述过去十年中PE住院的趋势。方法：我们分析了1993至2012年的全国住院患者样本数据，以确定PE患者的入院情况。我们纳入了国际疾病分类第9版的入院情况，代码将PE列为主要诊断，以及将PE列为呼吸衰竭或DVT主要诊断的次要诊断的入院。重度PE定义为机械通气、血管升压剂或非感染性休克。结果包括住院时间、调整后的费用和各种原因的住院死亡率。结果：PE的入院率从1993年的23/10万上升到2012年的65/10万(P<；.001)。符合大规模PE标准的录取比例下降(5.3%至4.4%，P=.002)，但大规模PE的绝对录取人数增加(从每10万人中1.5人增加至2.8人，P<；.001)。中位住院时间从8天(四分位数范围[IQR]，6-11)下降到4天(IQR，3-6)(P<；.001)。调整后的医院费用从1993年的16,475美元(智商，10,748-26,211美元)增加到2012年的25,728美元(智商，15,505-44,493美元)(P<；.001)。全因住院死亡率从7.1%下降到3.2%(P<；.001)，但人口调整的PE住院死亡从1.6/10万增加到2.1/10万(P<；.001)。结论：在过去的20年里，PE的总入院人数和住院费用都有所增加。然而，人口调整的住院率与严重PE患者的发生率不成比例地增加。我们假设，这些发现反映了一个令人担忧的全国性运动，即更多地接纳不那么严重的PE。
BACKGROUND: Pulmonary embolism ( PE) remains a significant cause of hospital admission and health-care costs. Estimates of PE incidence came from the 1990s, and data are limited to describe trends in hospital admissions for PE over the past decade.METHODS: We analyzed Nationwide Inpatient Sample data from 1993 to 2012 to identify patients admitted with PE. We included admissions with International Classification of Diseases, 9th revision, codes listing PE as the principal diagnosis as well as admissions with PE listed secondary to principal diagnoses of respiratory failure or DVT. Massive PE was defined by mechanical ventilation, vasopressors, or nonseptic shock. Outcomes included hospital lengths of stay, adjusted charges, and all-cause hospital mortality. Linear regression was used to analyze changes over time.RESULTS: Admissions for PE increased from 23 per 100,000 in 1993 to 65 per 100,000 in 2012 (P < .001). The percent of admissions meeting criteria for massive PE decreased (5.3% to 4.4%, P = .002), but the absolute number of admissions for massive PE increased (from 1.5 to 2.8 per 100,000, P < .001). Median length of stay decreased from 8 (interquartile range [IQR], 6-11) to 4 (IQR, 3-6) days (P < .001). Adjusted hospital charges increased from $16,475 (IQR, $10,748-$26,211) in 1993 to $25,728 ( IQR, $15,505-$44,493) in 2012 (P < .001). All-cause hospital mortality decreased from 7.1% to 3.2% (P < .001), but population-adjusted deaths during admission for PE increased from 1.6 to 2.1 per 100,000 (P < .001).CONCLUSIONS: Total admissions and hospital charges for PE have increased over the past two decades. However, the population-adjusted admission rate has increased disproportionately to the incidence of patients with severe PE. We hypothesize that these findings reflect a concerning national movement toward more admissions of less severe PE.