F-19 | Hospital location and teaching status disparities in outcomes of patients admitted with pulmonary embolism: A 5-year United States study

There are limited data on the hospital-level outcomes of patients with pulmonary embolism (PE) based on location and teaching hospital status. All adult (>18 years) non-elective admissions with a primary diagnosis of PE, admitted to rural, urban non-teaching, and urban teaching hospitals were identified using the National Inpatient Sample (2016-2020). The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, hospitalization costs, and discharge disposition. During 01/01/2016 to 12/31/2020, 904,259 PE admissions were identified. Urban teaching, urban non-teaching, and rural hospitals had 69.1%, 21.9% and 8.9% of admissions respectively. Compared to urban teaching hospitals, urban non-teaching, and rural hospitals had higher rates of white race (urban teaching 65.8 %, urban non-teaching 74.6%, rural 81.7 %), higher low socioeconomic status (urban teaching 21.3%, urban non-teaching 11.1 %, rural 12.1%),), and lower rates of Medicare admissions (urban teaching 50.6 %, urban non-teaching 53.5%, rural 58.8%) (all p<0.001). Urban teaching hospitals had higher rates of respiratory failure of 26.8% (urban non-teaching 25.4%, rural 24.4%), and bleeding complications (urban teaching 6.3 %, urban non-teaching 5.2 %, rural 4.5%), compared to urban non-teaching and rural hospitals (all p<0.001). In urban teaching hospitals, compared to medium and small sized ones, use of catheter-directed thrombolytics (urban teaching 4.1%, rural 1.7%), mechanical thrombectomy (urban teaching 1.6%, urban non-teaching 0.1%, rural 0.3%), and systemic thrombolysis (urban teaching 3.4%, urban non-teaching 2.61%, rural 1.1%) were the highest (all p<0.001). Urban teaching hospitals had higher rates of unadjusted in-hospital mortality (urban teaching 3.4%, urban non-teaching 2.4%, rural 2.2%) longer hospital stay (urban teaching 4.5±0.1 days, urban non-teaching 3.9±0.2 days, rural 3.5±0.2 days) and hospitalization costs ($53,953±417, $47322±4605, $27641 ± 348) (all p<0.001). In this five-year study, PE admissions to urban teaching hospitals had higher comorbidity, acuity of illness, and worse outcomes despite higher use of advanced definitive therapies.