Differential impact of venous thromboembolism and metastatic disease on in-hospital mortality and 30-day readmission in pancreatic cancer: A Nationwide Readmissions Database analysis.

Abstract

e16445 Background: Pancreatic cancer is associated with a high incidence of venous thromboembolism (VTE), early mortality, and frequent unplanned readmissions. While VTE is a known adverse prognostic factor and metastatic disease drives healthcare utilization, their relative contributions to short-term mortality versus rehospitalization in real-world practice remain incompletely defined. Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database 2022. Adult index admissions for pancreatic cancer were classified by VTE phenotype and metastatic status. Outcomes were in-hospital mortality (index and readmission hospitalizations) and 30-day all-cause readmission. Multivariable logistic regression and Cox proportional hazards models were used, adjusting for demographic, socioeconomic, hospital, and clinical severity variables. Results: Among 58,340 survey-weighted index admissions, 52,199 patients survived to discharge and were included in the readmission analysis. VTE was present in 12.0% of admissions and occurred more frequently in metastatic disease. Patients with VTE and/or metastatic cancer had substantially higher acuity, with increased rates of sepsis, shock, acute kidney injury, ICU admission, and mechanical ventilation, and were more often treated at large, urban teaching hospitals. Metastatic cases accounted for 57.8% of 30-day readmissions and the majority of in-hospital deaths. In time-to-event analyses, metastatic disease independently increased the hazard of 30-day readmission (adjusted HR 1.11, 95% CI 1.05–1.18; p < 0.001). In contrast, VTE phenotype was not associated with time to readmission, and no significant interaction between VTE subtype and metastatic status was observed. In-hospital mortality demonstrated a different pattern. Pulmonary embolism was independently associated with increased odds of death (adjusted OR 1.56, 95% CI 1.09–2.23; p = 0.016), and metastatic disease was the strongest predictor of mortality (adjusted OR 1.83, 95% CI 1.67–2.00; p < 0.001). The absence of a significant VTE–metastasis interaction indicated that the adverse prognostic impact of VTE on survival was consistent across disease stages. Mortality was further driven by sepsis, acute kidney injury, ventilation, while treatment at teaching and large-bed hospitals was associated with lower adjusted mortality. Conclusions: In pancreatic cancer, VTE—particularly pulmonary embolism—primarily magnifies in-hospital mortality, whereas metastatic burden is the dominant determinant of early readmission. These findings highlight the need for intensified inpatient thromboembolic management to reduce early deaths and for enhanced postdischarge care pathways for patients with metastatic disease to mitigate rehospitalization.