Clancy W Mullan1, Joshua Newman2, Merideth Geib3, Matthew D Pichert4, Areo Saffarzadeh4, Alan Hartman2, Brian Lima2. 1. Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut. Electronic address: clancy.mullan@yale.edu. 2. Department of Cardiovascular and Thoracic Surgery, Zucker School of Medicine, Manhasset, New York. 3. Department of Cardiothoracic Surgery, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas. 4. Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Abstract
BACKGROUND: Pulmonary embolism is common, but the benefit of surgical embolectomy remains unclear. National trends in embolectomy have been described to 2008. Recent data are lacking. We characterized the national trends in incidence, management, and outcomes of pulmonary embolisms, along with the population-level outcomes. METHODS: The National Inpatient Sample was queried by International Classification of Diseases-9th Revision codes for pulmonary embolisms from 2011 to 2014. Saddle embolisms, shock, and interventions, including systemic thrombolysis, catheter-directed therapy, extracorporeal membrane oxygenation, and pulmonary embolectomy, were identified. Predictors of in-hospital death were identified by logistic regression. RESULTS: We identified 1,283,063 embolism records, including 34,040 (2.6%) with saddle embolism, 31,057 (2.4%) with shock, and 1768 (0.14%) had saddle embolism with shock. Embolectomy and catheter-directed therapies were associated with reduced death in saddle embolism with shock (n = 1768; embolectomy: odds ratio [OR], 0.30; 95% confidence interval [CI], 0.19-0.48; catheter-directed therapies: OR, 0.68; 95% CI, 0.49-0.96). Systemic thrombolytics were not associated with a in-hospital death difference (OR, 1.10; 95% CI, 60.87-1.38). Extracorporeal membrane oxygenation was associated with increased death (OR, 2.07; 95% CI, 1.09-3.92). The number needed to treat for in-hospital death of saddle embolisms with shock was 4.7 (95% CI, 3.9-6.9). CONCLUSIONS: In this contemporary nationally representative sample, surgical embolectomy and catheter-directed therapies were associated reduced in-hospital death for saddle pulmonary embolism with shock, and systemic thrombolytics were not associated with in-hospital death.
BACKGROUND:Pulmonary embolism is common, but the benefit of surgical embolectomy remains unclear. National trends in embolectomy have been described to 2008. Recent data are lacking. We characterized the national trends in incidence, management, and outcomes of pulmonary embolisms, along with the population-level outcomes. METHODS: The National Inpatient Sample was queried by International Classification of Diseases-9th Revision codes for pulmonary embolisms from 2011 to 2014. Saddle embolisms, shock, and interventions, including systemic thrombolysis, catheter-directed therapy, extracorporeal membrane oxygenation, and pulmonary embolectomy, were identified. Predictors of in-hospital death were identified by logistic regression. RESULTS: We identified 1,283,063 embolism records, including 34,040 (2.6%) with saddle embolism, 31,057 (2.4%) with shock, and 1768 (0.14%) had saddle embolism with shock. Embolectomy and catheter-directed therapies were associated with reduced death in saddle embolism with shock (n = 1768; embolectomy: odds ratio [OR], 0.30; 95% confidence interval [CI], 0.19-0.48; catheter-directed therapies: OR, 0.68; 95% CI, 0.49-0.96). Systemic thrombolytics were not associated with a in-hospital death difference (OR, 1.10; 95% CI, 60.87-1.38). Extracorporeal membrane oxygenation was associated with increased death (OR, 2.07; 95% CI, 1.09-3.92). The number needed to treat for in-hospital death of saddle embolisms with shock was 4.7 (95% CI, 3.9-6.9). CONCLUSIONS: In this contemporary nationally representative sample, surgical embolectomy and catheter-directed therapies were associated reduced in-hospital death for saddle pulmonary embolism with shock, and systemic thrombolytics were not associated with in-hospital death.
Authors: Rodrigo Jiménez-García; Romana Albaladejo-Vicente; Valentin Hernandez-Barrera; Rosa Villanueva-Orbaiz; David Carabantes-Alarcon; Javier de-Miguel-Diez; José Javier Zamorano-Leon; Ana Lopez-de-Andres Journal: Int J Environ Res Public Health Date: 2020-11-11 Impact factor: 3.390