The incidence and associated 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, associated factors, and clinical outcomes of PE following cardiac surgery in the United States. Methods: 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. Results: 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. Conclusions: 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.