Pulmonary Artery Aneurysms Diagnosed in Hospitalizations in the United States and the In-Hospital Outcomes: Insights From the National Inpatient Sample

Abstract Objective: This study aims to evaluate the incidence of pulmonary artery aneurysm (PAA) diagnoses among hospitalized patients and the outcome for these patients in the United States. Methods: This was a retrospective, observational cohort study performed in accordance with the STROBE and RECORD guidelines. The United States National Inpatient Sample 2016 to 2020 was analyzed for hospital admissions with a discharge diagnosis of PAA identified by the International Classification of Diseases, Tenth Revision, Clinical Modification code I28.1. Data on demographics, admission type, hospital characteristics, and comorbidities associated with PAA were collected. Backward stepwise logistic regression was used for the primary outcome of in-hospital mortality, and backward stepwise linear regression was used for secondary outcomes including length of stay and hospitalization cost. Results: There were 5,305 hospital admissions with patients who had a diagnosis of PAA between 2016 and 2020 (median age: 62 years; 53.1% (2,815/5,305) female). The in-hospital mortality rate for the cohort with PAA was 6.7% (355/5,305), and the median length of stay was 5 d. The median cost of inpatient care for patients with PAA was $17,526. The most common conditions associated with PAA were pulmonary arterial hypertension (1,440/5,305, 27.1%), secondary pulmonary hypertension due to left heart disease (1,395/5,305, 26.3%), pneumonia (1,125/5,305, 21.2%), pulmonary embolus (725/5,305, 13.7%), and unspecified secondary pulmonary hypertension (575/5,305, 10.8%). The factors most associated with in-hospital mortality were tuberculosis (odds ratio (OR): 22.67, 95% confidence interval (CI): 3.35–153.32, P = 0.001), liver failure (OR: 15.91, 95% CI: 6.31–40.09, P < 0.001), and Eisenmenger syndrome (OR: 12.05, 95% CI: 1.06–136.42, P = 0.044). Liver failure (coefficient 17.84, 95% CI: 12.99–22.67, P < 0.001) was most associated with longer lengths of stay, and iatrogenic complication (coefficient 64,590, 95% CI: 35,308–93,872, P < 0.001) was most associated with cost. Conclusions: PAA is an uncommon diagnosis among hospitalized patients and is associated with substantial in-hospital mortality, prolonged length of stay, and increased healthcare costs.