Paul D Stein1, Fadi Matta. 1. Department of Research, St. Mary Mercy Hospital, Livonia, MI 48154, USA. steinp@trinity-health.org
Abstract
BACKGROUND: There are insufficient data to assess the potential role of pulmonary embolectomy in patients with acute pulmonary embolism. METHODS: In-hospital all-cause case fatality rate with pulmonary embolectomy was assessed from the Nationwide Inpatient Sample from 1999 through 2008. RESULTS: Among unstable patients (in shock or ventilator-dependent), case fatality rate with embolectomy was 380 of 950 (40%). Among stable patients, case fatality rate was lower: 690 of 2820 (24%) (P <.0001). Case fatality rate in unstable patients was 39% in 1999-2003 and 40% in 2004-2008 (not significant), and in stable patients it was 27% in 1999-2003 and 23% in 2004-2008 (P=.01). Case fatality rates were lower in patients with a primary diagnosis of pulmonary embolism and even lower in patients with a primary diagnosis who had none of the comorbid conditions listed in the Charlson Index. Within each stratified group, patients with vena cava filters had a lower case fatality rate. CONCLUSIONS: Case fatality rate in unstable patients who underwent pulmonary embolectomy remained at 39%-40% from 1999-2003 to 2004-2008, and in stable patients it decreased only from 27% to 23%. Case fatality rates were lower in those with fewer comorbid conditions and in those who received a vena cava filter. Our data reflect average outcome in the US. It may be that experienced surgeons and an aggressive multidisciplinary team could obtain a lower case fatality rate.
BACKGROUND: There are insufficient data to assess the potential role of pulmonary embolectomy in patients with acute pulmonary embolism. METHODS: In-hospital all-cause case fatality rate with pulmonary embolectomy was assessed from the Nationwide Inpatient Sample from 1999 through 2008. RESULTS: Among unstable patients (in shock or ventilator-dependent), case fatality rate with embolectomy was 380 of 950 (40%). Among stable patients, case fatality rate was lower: 690 of 2820 (24%) (P <.0001). Case fatality rate in unstable patients was 39% in 1999-2003 and 40% in 2004-2008 (not significant), and in stable patients it was 27% in 1999-2003 and 23% in 2004-2008 (P=.01). Case fatality rates were lower in patients with a primary diagnosis of pulmonary embolism and even lower in patients with a primary diagnosis who had none of the comorbid conditions listed in the Charlson Index. Within each stratified group, patients with vena cava filters had a lower case fatality rate. CONCLUSIONS: Case fatality rate in unstable patients who underwent pulmonary embolectomy remained at 39%-40% from 1999-2003 to 2004-2008, and in stable patients it decreased only from 27% to 23%. Case fatality rates were lower in those with fewer comorbid conditions and in those who received a vena cava filter. Our data reflect average outcome in the US. It may be that experienced surgeons and an aggressive multidisciplinary team could obtain a lower case fatality rate.
Authors: Min Ku Chon; Yong Hyun Park; Jin Hee Choi; Sang Hyun Lee; Jeong Su Kim; Jun Kim; June Hong Kim; Kook Jin Chun Journal: J Korean Med Sci Date: 2014-04-25 Impact factor: 2.153
Authors: James Tsai; Scott D Grosse; Althea M Grant; Nimia L Reyes; W Craig Hooper; Hani K Atrash Journal: PLoS One Date: 2012-07-06 Impact factor: 3.240