Dismantling the Obesity Paradox in Acute Pulmonary Embolism

Abstract

Introduction: The “obesity paradox” has been a controversial topic in health outcome research. Age has been a significant cofounder and a new study is needed.

Purpose: To determine the relationship between obesity and in-hospital mortality, morbidity, and health care resource utilization in patients admitted to the hospital in the United States with acute pulmonary embolism (PE).

Method: A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Adults (≥ 18 years) with a principal diagnosis of acute PE and a secondary diagnosis of obesity were identified using ICD-9 codes as described in the literature. The primary outcome was in-hospital mortality. Secondary outcomes were length of hospital stay (LOS), and total hospitalization costs. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders.

Results: In total, 171,233 hospital admissions with a primary diagnosis of acute PE were identified, of which 16.4% were obese. The index inhospital moralities were not statistically different between obese and non-obese patients (1.9 vs 7.1%, p=0.24).

The 30-day readmission rate among were similar between the obese and non-obese patients (p=0.14). The most common reason for readmission was DVT (12%). Obesity and non-obese patients have similar LOS (p=0.46) and total hospital cost (p=0.52).

Conclusion: In this study, the mortality difference between obese and non-obese patients was not statistically significant. This clarifies that among acute PE patient, obesity paradox may not hold true.