The incidence and risk factors of pulmonary embolism after cardiac surgery: A retrospective nationwide inpatient sample database study

Background Cardiac surgery is associated with a significant risk of postoperative pulmonary embolism (PE), a life-threatening complication. This study sought to evaluate the epidemiology, risk factors, and clinical outcomes of PE following cardiac procedures in the United States. Methods Utilizing the National Inpatient Sample database, we conducted a retrospective analysis of patients who underwent cardiac surgery between 2010 and 2019. Univariate and multivariate analyses were performed to identify patient- and hospital-level factors associated with PE. Clinical outcomes, including in-hospital mortality, length of stay, and total charges, were also assessed. Results The incidence of PE following cardiac surgery increased from 0.6% in 2010 to 2.9% in 2019 ( p  < 0.001). Significant risk factors included female sex (OR: 1.123), Black race (OR: 1.108), a higher comorbidity burden (OR: 3.780 for  ≥ 3 comorbidities), Medicaid insurance coverage, and admission to larger or teaching hospitals. Patients who developed PE experienced significantly higher in-hospital mortality (16.2% vs. 5.5%, p  < 0.001), longer hospital stays (median 15.08 vs. 7.63 days, p  < 0.001), and increased total charges ($213,725 vs. $119,436, p  < 0.001). Conclusions This large-scale analysis reveals a concerning rise in the incidence of PE following cardiac surgery over the past decade. Identifying high-risk patient profiles and associated risk factors can guide targeted prevention strategies and optimize perioperative management to mitigate the substantial clinical and economic burden of this serious complication.