title: Case fatality rate with pulmonary embolectomy for acute pulmonary embolism.
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.
authors.affiliation: Department of Research, St. Mary Mercy Hospital, Livonia, MI 48154, USA. steinp@trinity-health.org
authors.forename: Paul D
authors.initials: PD
authors.lastname: Stein
authors.forename: Fadi
authors.initials: F
authors.lastname: Matta
mesh_terms: D015897:Comorbidity; D017128:Embolectomy / Q000009:adverse effects*; D006801:Humans; D011655:Pulmonary Embolism / Q000150:complications* / Q000601:surgery*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012769:Shock / Q000150:complications