Extracranial Systemic Embolic Events in a Nationally Representative Discharge Database

Abstract

Introduction: Systemic emboli affect the brain and extracranial sites resulting in ischemic events with high morbidity and mortality. Extracranial systemic embolic events (ESEEs) frequently affect aortic, iliac, mesenteric, kidney, upper and lower extremity sites. The understanding of factors associated with ESEEs is limited, but atrial fibrillation is likely a major ESEE risk factor. Methods: A retrospective cross-sectional study was completed using the largest publicly available all-payer inpatient care database, the National Inpatient Sample (NIS). All adult NIS discharges were included and atrial fibrillation and ESEE subgroups identified for analysis. Descriptive statistics, multivariable logistic and linear regression were used to assess the association between ESEEs and atrial fibrillation. Other outcomes included inpatient mortality, length of stay and total hospital charges. Results: Hospital discharges with ESEEs had higher inpatient mortality (10.3% vs 2.2%), longer length of stay (6 days vs 3 days) and higher total charges ($86,888 vs $30,737) than non-ESEE discharges. The discharges with concurrent atrial fibrillation were more likely to experience ESEEs, with the majority of events involving lower limbs, mesentery and kidneys. After adjustment for demographic, geographic and institutional factors, ESEEs remained associated with increased mortality, higher total hospital charges and longer length of stay. Discussion: ESEEs with concurrent atrial fibrillation were associated with high inpatient mortality, total hospital charges and longer length of stay. Overall, among all NIS discharges, the most frequent ESEE sites were the lower extremity, mesentery and iliac regions.