Clinical and economic implications of venous thromboembolism in pancreatic cancer patients: Evidence from the National Inpatient Sample.

667 Background: Venous thromboembolism (VTE) remains one of the most devastating complications of pancreatic cancer, often worsening clinical outcomes and straining healthcare resources. Despite its high prevalence and well-documented risks, comprehensive national-level data quantifying its impact remain limited, and implementation of systematic prevention strategies remains inconsistent in clinical practice. Methods: A retrospective analysis was performed using the 2021–2022 National Inpatient Sample (NIS). Adult hospitalizations with pancreatic cancer were identified by ICD-10 codes and stratified by the presence of VTE. Key outcomes included in-hospital mortality, use of critical care services, and total hospital charges. Multivariable logistic and linear regression models were used to evaluate associations, adjusting for demographics, insurance type, and hospital-location characteristics. Results: Among an estimated 46, 031 pancreatic cancer hospitalizations, 8. 8% were complicated by VTE. 19. 3%, 31%, 33%, and 16. 7% of the patients with pancreatic cancer were in age groups 18-59, 60-69, 70-79, and >80, respectively. 70% of these patients were White, while Black, Hispanic, and other races accounted for 13. 8%, 9. 1% and 7. 1%, respectively. After adjusting for confounders, patients with VTE had 90% higher odds of in-hospital death (aOR 1. 90, 95% CI 1. 70-2. 13; p<0. 001). VTE was further associated with greater ICU utilization (aOR 1. 16, 95% CI 0. 96-1. 39; p=0. 127), and higher hospitalization costs (60, 0000-104, 999 vs. 0 – 59, 999) (aOR 1. 03, 95% CI 0. 94-1. 13; p=0. 590). However, these were not statistically significant. Compared with White patients, adjusted odds of mortality were higher for Asian/Pacific Islander (aOR 1. 44, 95% CI 1. 21-1. 73; p<0. 001) and Black (aOR 1. 28, 95% CI 1. 15-1. 43; p<0. 001). Interestingly, rural hospitalization is associated with close to 60% higher adjusted odds of death. Conclusions: In U. S. hospitalizations for pancreatic cancer, VTE is associated with substantially higher inpatient mortality independent of age, mechanical ventilation, length of stay, and gender. However, after adjustment, VTE was not independently associated with ventilation or higher charges. These findings support targeted prevention and early recognition of VTE and highlight structural disparities (race and rural facility location) that warrant system-level interventions.