Risks and Outcomes of Perioperative Pulmonary Embolism in Major Surgeries: A Population-Based Study

Purpose: Perioperative pulmonary embolism (PE) is a significant cardiovascular complication in many surgeries. This study aimed to investigate the risks and outcomes of perioperative PE in major surgery. Methods: Discharge records of the Nationwide Readmission Database from 2010 to 2015 were extracted and analyzed. Length of stay, charges, death, and 30-day hospital readmission rate were compared for patients with and without perioperative PE. In addition, surgery-specific risk factors and therapies associated with PE were explored in a multivariable model. Findings: A total of 12,376,153 hospitalizations for major surgeries were involved, and perioperative PE occurred in 22,676 hospitalizations (0.18%). The length of stay, charges, rate of death, and 30-day hospital readmission were higher in patients with perioperative PE than in those without perioperative PE. Respiratory (odds ratios [OR], 2.09; 95% CI, 1.89-2.3), cardiovascular (OR, 1.62; 95% CI, 1.51- 1.73), and musculoskeletal (OR, 1.22; 95% CI, 1.1- 1.29) surgeries were risk factors for the occurrence of perioperative PE. In patients with perioperative PE, respiratory surgery was a risk factor for death (OR, 1.48; 95% CI, 1.10-2.00), whereas gynecologic/obstetric surgery was a protective factor for 30-day readmission (OR, 0.30; 95% CI, 0.10-0.88). Regarding therapy for perioperative PE, thrombolytic therapy (OR, 1.74; 95% CI, 1.26-2.42) and embolectomy (OR, 3.60; 95% CI, 2.35-5.51) were risk factors for death. Implications: Respiratory, cardiovascular, and musculoskeletal surgeries were risk factors for the occurrence of perioperative PE and death. Future research on precise models to predict PE in major surgeries is needed for appropriate interventions to improve outcomes of perioperative PE. (Clin Ther. 2021;43:1957-1968.) (c) 2021 Published by Elsevier Inc.