Abstract

Background: Existing studies have found that patient factors and disease severity prolong length of stay (LOS) for pulmonary embolism (PE), but similar Australian studies are lacking. Aims: To determine LOS and factors associated with increased LOS for PE at an Australian centre. Methods: We reviewed records of patients admitted with PE between 1/3/2019 and 28/2/2020. Our centre consists of a primary hospital (PH) and satellite hospital (SH). Patients may present to either the PH or SH, with patients from the SH being transferred to the PH if hospitalization is required. The LOS included time spent at SH and PH. Multivariable analysis using a generalized linear model and stepwise regression were used to identify factors associated with increased LOS. Results: 110 patients had a LOS of 3(3) days [median (IQR)]. The 21 patients who presented to the SH had a longer LOS compared to PH [5(3) vs 3(4) days, p=0.035]. 48% had low-risk PE (Simplified PE severity index=0). Factors associated with increased LOS were warfarin anticoagulation (p=0.005), allied health input in care (p=0.03), more inpatient medical issues (p=0.07), initial presentation to SH (p=0.05), any comorbidity (p=0.06) and completion of venous doppler studies (p=0.003). Statistical significance was defined as p<0.1 due to our modest sample size. Conclusion:  The factors which prolonged LOS at an Australian centre concur with existing studies. Our LOS could be reduced by improving imaging access, outpatient management of low-risk PE, using management algorithms for PE to avoid interhospital transfer and using alternatives to warfarin. Future studies are needed to assess the impact of these interventions on LOS and health expenditure.