Nationwide outcomes of surgical embolectomy for acute pulmonary embolism

Abstract

Objective: The aim of the present study was to review nationwide outcomes of surgical embolectomy for acute pulmonary embolism.

Methods: Adult patients undergoing surgical embolectomy for acute pulmonary embolism from 1999 to 2008 were identified in the weighted Nationwide Inpatient Sample. The primary endpoint was inpatient mortality. Multivariate logistic regression analysis incorporating significant univariate predictors (P < .2) was conducted to identify independent predictors of inpatient mortality.

Results: There were 2709 eligible patients identified as undergoing surgical embolectomy for acute pulmonary embolism during the study period. The mean age was 57.0 ± 16.0 years. Of the patients, 1242 (45.8%) were women. A total of 280 patients (10.3%) had undergone thrombolysis before surgical embolectomy. The overall inpatient mortality rate was 27.2%. On multivariate analysis, an increasing Charlson comorbidity index (odds ratio, 1.37; 95% confidence interval, 1.12-1.69; P = .003) significantly increased the odds of inpatient mortality. In addition, blacks were more than twofold more likely to die during hospitalization than whites (odds ratio, 2.29; 95% confidence interval, 1.18-4.46; P = .02). Although age, payment type, hospital location (urban versus rural), hospital embolectomy volume, and surgeon embolectomy volume were associated with inpatient mortality on univariate analysis (each P < .2), none of these factors correlated with mortality in the multivariate model.

Conclusions: This large-cohort analysis of more than 2700 patients demonstrates a nationwide inpatient mortality rate of 27.2% after pulmonary embolectomy. Although patient factors affect mortality, the arena of care appears to have no significant effect on operative outcomes. This suggests that it might be more prudent for centers with qualified surgeons to avoid delays in treatment, rather than transfer care because of a perception of improved outcomes.