Early discharge for low-risk pulmonary embolism patients linked to fewer complications, lower costs

Patients with low-risk pulmonary embolism (LRPE) who were discharged from the hospital within two days had better clinical outcomes and resulted in cost savings when compared to those with longer stays, according to a study in PLOS One.

There were no differences in adverse pulmonary embolism events—a composite of recurrent venous thromboembolism, major bleeding and death—but patients with longer stays had more hospital-acquired complications (HACs). In total, 13.3 percent of patients with a long length of stay (LOS) developed HACs. Only 1.5 percent of patients discharged within two days developed HACs.

“PE is one of the leading causes of cardiovascular morbidity and mortality,” wrote lead researcher Li Wang, PhD, and colleagues. “The key to effective treatment lies in the appropriate risk stratification–low-risk patients can benefit from abbreviated hospital stays or outpatient therapy, which can reduce the economic burden of the disease. In our study, we found that in a real-world clinical setting, LRPE patients with a short LOS have better clinical outcomes at lower costs than those with a long LOS.”

Wang et al. considered data from 6,746 PE patients from the Veterans Health Administration (VHA) population. More than 95 percent were men.

From that initial sample, the researchers evenly split 784 LRPE patients to a short LOS group or a long LOS group. Both cohorts were well-balanced in terms of baseline characteristics.

In addition to the clinical benefit detected in the short LOS group, Wang and co-authors also observed average savings for inpatient ($2,164 vs. $5,100), total medical ($7,843 vs. $11,135) and total costs ($9,056 vs. $12,544).

However, they wrote, “it is difficult to determine whether a longer LOS is caused by medical complications or that a longer LOS caused the complications.” Also, since the study focused on VHA veterans who were mostly elderly men, the results may not be consistent in females or younger males.

Despite those limitations, the authors believe their findings show the importance of risk stratification in PE patients. Some American and European professional organizations have guidelines supporting treatment of LRPE patients in an outpatient setting, but Wang and colleagues noted patients at greater risk are better off with longer hospital stays.

“Previous studies observed that PE patients with a shorter LOS had higher post-discharge mortality, implying that the physicians may inappropriately select those patients at a higher risk for complications for early discharge,” they wrote. “Hence, outpatient and early discharge should only be considered in low-risk PE patients.”