Introduction: Surgical thrombectomy can be life saving in patients with acute massive pulmonary embolism (PE). However, contemporary data on the utilization and outcomes of surgical thrombectomy in acute massive PE are lacking.
Methods: we utilized the national inpatient sample to identify patients with acute massive PE who were treated with surgical thrombectomy. Temporal trend in the utilization and in-hospital mortality were assessed.
Results: out of 389,518 patients who were admitted with acute PE between 2003-2014, 701 patients (0.2%) were treated with surgical thrombectomy. The utilization of surgical thrombectomy remained stable during the study period (p=0.1). Patients who were treated with surgical thrombectomy were younger, more likely to be female and more likely to be treated at teaching institutions (56 ± 16 vs 62 ±17, 53% vs. 45.7% and 74% vs. 45%, p<0.0001). The majority of these surgeries were performed in the first 48 hours of presentation (77.4%). In-hospital mortality following surgical thrombectomy decreased significantly from 27% in 2003 to 13.6% in 2014 (p<0.001) (Figure-1). There was no significant difference in in-hospital mortality between patients who underwent surgical thrombectomy in the first 48 hours vs. those who had surgery later on (16.9% vs. 14.5%, p=0.571).
Conclusion: the outcomes of surgical thrombectomy have improved significantly in the last decade. With the paradigm shift towards a multidisciplinary management of patients with acute PE (especially those with massive PE), these data have important implications in the triaging and risk stratification of this high-risk population.