National Outcomes of Surgical Embolectomy for Acute Pulmonary Embolism.

Abstract Background Guidelines outlining the role of surgical embolectomy for acute pulmonary embolism remain consensus based, however recent outcomes have improved compared to traditional experiences. The purpose of this study was to examine contemporary outcomes of patients treated for acute pulmonary embolism on a nationwide scale. Methods Patients undergoing systemic thrombolysis, catheter-directed therapy, and surgical embolectomy for acute pulmonary embolism from 2010-2014 in the National Inpatient Sample were included. Results A total 58,974 patients with acute pulmonary embolism were included. Of these, 33,553 were treated with systemic thrombolysis, 22,336 with catheter-directed therapy, and 3,085 underwent surgical embolectomy. Thrombolysis was the most common, with a substantial increase after 2012, while surgical volumes remained stable. The surgical group, compared to systemic thrombolysis and catheter-directed therapy, had more saddle emboli (22% vs. 10% vs. 10%) and were more frequently at severe risk of mortality (56% vs. 42% vs. 26%; both P 60 years, atrial fibrillation and non-saddle embolus were associated with increased odds of mortality. Conclusions In this contemporary, real-world study, mortality occurred in 19.8% of patients undergoing surgical embolectomy for acute pulmonary embolism. This represents a significant improvement compared to traditional outcomes and supports the role of surgery in the multidisciplinary treatment of this high-risk condition.