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A Statewide Perspective

Drahomir Aujesky, MD, MSc; Roslyn A. Stone, PhD; Sunghee Kim, MS; Elsa J. Crick, MS; Michael J. Fine, MD, MSc

Arch Intern Med. 2008;168(7):706-712.

Background  The optimal length of stay (LOS) for patients with pulmonary embolism (PE) is unknown. Although reducing LOS is likely to save costs, the effects on patient safety are unclear. We sought to identify patient and hospital factors associated with LOS and assess whether LOS was associated with postdischarge mortality.

Methods  We evaluated patients discharged with a primary diagnosis of PE from 186 acute care hospitals in Pennsylvania (January 2000 through November 2002). We used discrete survival models to examine the association between (1) patient and hospital factors and the time to discharge and (2) LOS and postdischarge mortality within 30 days of presentation, adjusting for patient and hospital factors.

Results  Among 15 531 patient discharges with PE, the median LOS was 6 days, and postdischarge mortality rate was 3.3%. In multivariate analysis, patients from Philadelphia were less likely to be discharged on a given day (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.73-0.93), as were black patients (OR, 0.88; 95% CI, 0.82-0.94).The odds of discharge decreased notably with greater patient severity of illness and in patients without private health insurance. Adjusted postdischarge mortality was significantly higher for patients with an LOS of 4 days or less (OR, 1.55; 95% CI, 1.21-2.00) relative to those with an LOS of 5 to 6 days.

Conclusions  Several hospital and patient factors were independently associated with LOS. Patients with a very short LOS had greater postdischarge mortality relative to patients with a typical LOS, suggesting that physicians may inappropriately select patients with PE for early discharge who are at increased risk of complications.

Author Affiliations: Division of Internal Medicine, University of Lausanne, Lausanne, Switzerland (Dr Aujesky);VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (Drs Stone and Fine and Mss Kim and Crick), Pittsburgh,Pennsylvania; Department of Biostatistics, Graduate School of Public Health (Dr Stone and Ms Kim), and Division of General Internal Medicine, Department of Medicine (Dr Fine), University of Pittsburgh, Pittsburgh.

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