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Introduction Pulmonary embolism (PE) is a common cause of unplanned admission with substantial variation in hospital length of stay (LOS). Identifying factors associated with prolonged LOS may support early discharge planning and improve bed utilisation. We evaluated clinical, biochemical and imaging predictors of LOS in patients admitted with confirmed PE.Methods We conducted a retrospective observational cohort study using routinely collected electronic health record data from an acute hospital between July 2020 and February 2020. Adults with confirmed PE and a recorded PE risk category were included. LOS (days) was calculated from admission to discharge. Candidate predictors included demographics, haemodynamic instability, PE risk category, CTPA clot phenotype, thrombolysis and critical care admission, comorbidities, and laboratory biomarkers. Univariable and multivariable linear regression were used to identify predictors of LOS; estimates were reported with 95% confidence intervals.Results Among 31,086 cardiac referrals, 188 patients had confirmed PE. Of these, 144 (76.6%) had LOS <10 days and 44 (23.4%) had LOS ≥10 days. Patients with prolonged LOS were older (76.3±13.5 vs 66.5±15.0 years; p<0.001) and had higher PE risk category distribution (p=0.007). In-hospital mortality was higher in the ≥10-day group (22.7% vs 8.3%; p=0.020). Haemodynamic instability was uncommon and did not differ by LOS category. D-dimer levels and CTPA clot distribution were not associated with LOS.In regression analyses, age was associated with longer LOS in univariable analysis but not after adjustment. In the multivariable model, higher urea and lower creatinine were independently associated with longer LOS, while higher INR was associated with shorter LOS. Albumin was associated with LOS in univariable analysis but not after adjustment. Inflammatory markers, D-dimer, troponin, haemodynamic instability and clot phenotype were not independently associated with LOS.Conclusion In this real-world cohort of patients admitted with acute PE, prolonged hospital stay was associated with older age, higher PE risk category and increased in-hospital mortality. Renal and biochemical indices were independently associated with LOS, suggesting that early recognition of physiological complexity may facilitate proactive discharge planning and reduce unnecessary bed days following PE.