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

Cardiac surgery is associated with a significant risk of postoperative pulmonary embolism (PE), a life-threatening complication. This study sought to evaluate the epidemiology, associated factors, and clinical outcomes of PE following cardiac surgery in the United States. Using the National Inpatient Sample (NIS) database, we conducted a retrospective analysis of patients who underwent cardiac surgery between 2010 and 2022. 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, stratified by pre-COVID (2010–2019) and COVID-era (2020−2022) periods. The incidence of PE following cardiac surgery significantly increased from 0.6% in 2010 to 3.2% in 2022, and remained elevated during the 2020–2022 period. Independent associated factors included female sex, Black race, a higher comorbidity burden (≥3 comorbidities), Medicaid insurance coverage, admission to large or teaching hospitals, and prolonged hospitalization (> 9 days). High-risk comorbidities included metastatic cancer, drug abuse, and pulmonary circulation disorders. PE development was associated with increased in-hospital mortality, prolonged hospitalization, and increased total charges. This large-scale analysis reveals a rise in the incidence of PE following cardiac surgery over the past decade. Identifying high-risk patient profiles and associated factors can guide targeted prevention strategies and optimize perioperative management to mitigate the substantial clinical and economic burden of this severe complication.