Smoking tied to more pulmonary embolism, leading to higher readmission rates

NEW ORLEANS — In a new study, hospital readmission rates for pulmonary embolism were increased for active smokers compared with nonsmokers.

The retrospective study focused on 2014 data from the AHRQ-HCUP Nationwide Readmission Database for U.S. adults with a principal diagnosis of PE and a secondary diagnosis of tobacco dependence. Of 171,233 hospital admissions for PE, one-third of patients reported active smoking. The researchers used propensity score matching to pair 24,262 active smokers with PE with 24,262 nonsmokers with PE.

“Our data show that 34.2% were active smokers at the time of their hospitalization; hence, we questioned, ‘is smoking worth the risk?’ Kam Sing Ho, MD, from Mount Sinai St. Luke’s and Mount Sinai West, told Healio Pulmonology.

The primary outcome — all-cause readmission within 30 days — occurred in 11% of smokers compared with 8.9% of nonsmokers (P < .001). In both groups, the most common cause of readmission was PE (69.6%), according to data presented by Ho at the CHEST Annual Meeting.

In a new study, hospital readmission rates for pulmonary embolism were increased for active smokers compared with nonsmokers.

Source: Shutterstock

“This is the first study to quantify the increased rate of hospital readmission due to smoking,” Ho said.

Risk for mortality was 6.27% among patients readmitted within 30 days, compared with 3.16% among the index admissions (P < .001).

In 2014, 78,592 hospital days were associated with readmissions, according to the results. The total health care in-hospital economic burden associated with readmissions was $168 million in costs and $615 million in charges, according to the results.

Smoking was identified as an independent predictor associated with higher readmission rates (HR = 1.29; 95% CI, 1.04-1.59; P < .01). Other predictors included female sex, atrial fibrillation, need for in-hospital oxygen, Medicare insurance and higher Charlson comorbidity score. Private insurance and higher income were identified as predictors of lower readmission risk, according to the researchers.

Looking ahead, Ho said future research efforts will focus on implementation of inpatient smoking-cessation strategies at the local hospital level, and the effect on readmission rates, utilization of health resources and mortality.

“Previous reports have shown that smoking-cessation services are underutilized within the hospital. Given that smoking is a common phenomenon among patients admitted with pulmonary embolism, we suggest that more rigorous smoking-cessation services implemented prior to discharge for all active smokers [would be useful],” Ho told Healio Pulmonology. – by Katie Kalvaitis

Reference:

Ho KS, et al. Poster E1136. Presented at: CHEST Annual Meeting; Oct. 19-23, 2019; New Orleans.

Disclosure: Ho reports no relevant financial disclosures.