From the Guidelines
The typical length of hospitalization for patients with pulmonary embolism (PE) can be as short as 24-48 hours for low-risk patients, with some patients even being managed entirely as outpatients with appropriate anticoagulation therapy, as supported by the most recent study from 2021 1.
Key Considerations for Hospitalization Length
- The severity of the PE and the patient's clinical stability are primary factors in determining hospitalization length.
- Patients with high-risk PE, significant comorbidities, or complications may require longer hospital stays, often ranging from 1-2 weeks or more.
- The use of direct oral anticoagulants (DOACs) such as rivaroxaban can facilitate shorter hospital stays, as seen in studies where rivaroxaban treatment resulted in a mean reduction in length of stay (LOS) compared to traditional anticoagulant therapies 1.
- Clinical decision rules, like the Pulmonary Embolism Severity Index, can help identify low-risk patients suitable for home treatment, further reducing the need for prolonged hospitalization 1.
Factors Influencing Discharge
- Hemodynamic stability
- Clinical improvement
- Adequate oxygen levels
- Ability to tolerate oral medications
- Establishment of a safe anticoagulation plan, which typically involves transitioning to oral anticoagulants like DOACs or warfarin for at least 3 months after discharge to prevent recurrence.
Recent Evidence and Recommendations
The most recent guidelines and studies, including those from 2020 1 and 2021 1, support the concept of early discharge and home treatment for low-risk PE patients, emphasizing the importance of individualized care based on patient risk factors and response to initial treatment. Early discharge and outpatient management are considered safe and effective for selected patients with acute low-risk pulmonary embolism, as evidenced by low rates of symptomatic recurrent venous thrombo-embolism or pulmonary embolism-related death within 3 months 1.
From the Research
Length of Hospitalization for Pulmonary Embolism
The length of hospitalization for patients with pulmonary embolism can vary based on several factors, including the severity of the condition, the patient's overall health, and the treatment approach.
- A study published in 2017 2 found that the median hospital stay for patients with pulmonary embolism was 10 days, with a range of 7 to 14 days.
- Another study from 2008 3 reported a median length of stay of 6 days, with a postdischarge mortality rate of 3.3%.
- The length of hospitalization may also depend on the patient's risk level, with higher-risk patients potentially requiring longer hospital stays.
- A review of acute pulmonary embolism published in 2022 4 discussed the importance of early diagnosis and treatment, but did not provide specific guidance on the length of hospitalization.
- A study on the long-term management of pulmonary embolism published in 2022 5 highlighted the need for individualized treatment plans and rehabilitation, but did not address the length of hospitalization directly.
- A comparison of mechanical thrombectomy versus routine care for elevated risk acute pulmonary embolism published in 2022 6 found that the average total hospital length of stay was similar between the two groups, but did not provide a specific median length of stay.
Factors Influencing Length of Hospitalization
Several factors can influence the length of hospitalization for patients with pulmonary embolism, including:
- Severity of the condition, as measured by the Pulmonary Embolism Severity Index (PESI) or other scoring systems 2, 6
- Patient's overall health and comorbidities 3
- Treatment approach, including the use of anticoagulation, thrombolysis, or mechanical thrombectomy 4, 6
- Hospital and patient factors, such as insurance status and geographic location 3