Influence of recent immobilization and recent surgery on mortality in patients with pulmonary embolism.
BACKGROUND
The influence of recent immobilization or surgery on mortality in patients with pulmonary embolism (PE) is not well known.


METHODS
We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) data to compare the 3-month mortality rate in patients with PE, with patients categorized according to the presence of recent immobilization, recent surgery, or neither.


RESULTS
Of 18,028 patients with PE, 4169 (23%) had recent immobilization, 2212 (12%) had recent surgery, and 11,647 (65%) had neither. The all-cause mortality was 10.0% (95% confidence interval [CI] 9.5-10.4), and the PE-related mortality was 2.6% (95% CI 2.4-2.9). One in every two patients who died from PE had recent immobilization (43%) or recent surgery (6.7%). Only 25% of patients with immobilization had received prophylaxis, as compared with 65% of the surgical patients. Fatal PE was more common in patients with recent immobilization (4.9%; 95% CI 4.3-5.6) than in those with surgery (1.4%; 95% CI 1.0-2.0) or those with neither (2.1%; 95% CI 1.8-2.3). On multivariate analysis, patients with immobilization were at increased risk for fatal PE (odds ratio 2.2; 95% CI 1.8-2.7), with no differences being seen between patients immobilized in hospital or in the community.


CONCLUSIONS
Forty-three per cent of patients dying from PE had recent immobilization for ≥4 days. Many of these deaths could have been prevented.
Hospital La Fe, Valencia, Spain.
D
D
Nauffal
M
M
Ballester
R Lopez
RL
Reyes
D
D
Jiménez
R
R
Otero
R
R
Quintavalla
M
M
Monreal
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000401:mortality*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*