Pulmonary Embolism With Tobacco Dependence Linked to 30-Day Readmission

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2019 meeting, taking place in New Orleans, LA. Our staff will report on medical research related to asthma, COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2019.

NEW ORLEANS — Patients with tobacco dependence and pulmonary embolism (PE) are likely to be readmitted to the hospital within 30 days of initial discharge due to pulmonary embolism, according to research presented at the 2019 CHEST Annual Meeting, held October 19 to 23, 2019, in New Orleans, Louisiana.

Researchers conducted a retrospective study to examine the relationship between tobacco dependence and 30-day hospital readmission, mortality, morbidity, and healthcare resource utilization in patients with PE who smoke.

Data were pulled from the Agency for Healthcare Research and Quality-Healthcare Cost and Utilization Project Nationwide Readmission Database for 2014 and included information on adults with a principal diagnosis of PE and a secondary diagnosis of tobacco dependence. The primary outcome for the study was the rate of all-cause 30-day readmission; secondary outcomes included the reasons for readmission, readmission mortality rate, morbidity, and resource use.

Overall, 171,233 hospital admissions were identified; 34.2% of these admissions had a secondary diagnosis of tobacco dependence. Following propensity score matching, 24,262 patients with PE and tobacco dependence were paired with 24,262 patients with PE without tobacco dependence. Among smokers and nonsmokers with PE, the 30-day readmission rates were 11.0% and 8.9%, respectively; the most common readmission for both groups was PE (69.6%).

Patients who were readmitted had significantly higher mortality compared with index admissions (6.27% vs 3.16%; P <.001). In total, 78,592 hospital days were associated with readmission, as well as an in-hospital economic burden of $168 million in costs and $615 million in charges.

Tobacco dependence was an independent predictor associated with higher risks for 30-day readmission (hazard ratio, 1.29; 95% CI, 1.04-1.59; P <.01). Other factors predictive of readmission were being a woman, having atrial fibrillation, requiring in-hospital oxygen, being enrolled in Medicare insurance, and having higher Charlson comorbidity. Conversely, private insurance and higher income were associated with a lower risk for readmission.

“The high prevalence of smokers among PE admission and the detrimental outcomes prompts an urgent need for smoking cessation,” the researchers concluded. “In hospital smoking cessation services are underutilized.”

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Reference

Ho KS, Wu LL, Sheehan J, Salonia J. Is smoking worth the risk? Increased 30-day readmission among smokers with pulmonary embolism: a propensity score match analysis. Presented at: CHEST Annual Meeting 2019; October 19-23, 2019; New Orleans, LA. Abstract 1787.