Short-term outcomes of thrombolysis versus surgical pulmonary embolectomy in patients with high-risk pulmonary embolism.

Abstract

The survival benefit of thrombolysis compared with surgical pulmonary embolectomy for high-risk pulmonary embolism has not been established, although current guidelines advocate thrombolysis as first-line therapy. This study compared the short-term outcomes of surgical pulmonary embolectomy and thrombolysis to determine the optimal treatment for high-risk pulmonary embolism. Patients with high-risk pulmonary embolism who underwent surgical pulmonary embolectomy or thrombolysis within 2 days of admission were identified using a nationwide inpatient administrative database in Japan between July 2010 and March 2023. The primary outcome was in-hospital mortality, and secondary outcomes were complications, length of hospital stay, and total hospitalization costs. Outcomes were compared using overlap weighting, with sensitivity analyses conducted using inverse probability of treatment weighting and multivariate logistic regression model. Of the 2813 eligible patients, 526 underwent surgical pulmonary embolectomy, and 2287 underwent thrombolysis. After overlap weighting, surgical pulmonary embolectomy was associated with lower in-hospital mortality (22.2% vs 30.1%, P = .002), more favorable neurological outcomes at discharge (72.5% vs 66.7%, P = .040), and higher total costs ($30,548 vs $13,374, P < .001) than thrombolysis. No significant differences were observed in complications or length of hospital stay between the 2 groups. Sensitivity analyses yielded results consistent with the primary analyses. These findings suggest potential benefits of surgical pulmonary embolectomy over thrombolysis for high-risk pulmonary embolism. Surgical pulmonary embolectomy may be considered a reasonable reperfusion therapy option for suitable patients. Further research is needed to confirm these findings.