Evaluating the Influence of Socioeconomic Factors, Race, and Obesity on In-Hospital-Mortality and Length of Stay Following Mechanical Thrombectomy for Acute Pulmonary Embolism

Purpose: As interventional procedures become more commonly utilized for the treatment of pulmonary embolisms, it is important to understand the social determinants surrounding outcomes of this procedure, to identify areas of improvement. This study aims to evaluate the impact of socioeconomic status, race, and obesity on length of stay and mortality following mechanical thrombectomy for acute pulmonary embolisms.

Materials and Methods: A retrospective analysis was conducted using the 2017 NIS database. 333 Patients who underwent mechanical thrombectomy for pulmonary embolisms were categorized by geographic region (West, South, Midwest, Northeast), race (White, Black, Hispanic, Asian-Pacific-Islander, Native American, Other), insurance type (Medicare, private, self-pay), hospital setting (urban-teaching, urban-non-teaching, rural), and obesity status. ANOVA was used for comparing mean length of stay. Additionally, 42 patients who had a reported in-patient mortality following mechanical thrombectomy for pulmonary embolism were sub-selected. This subset was age and gender matched to 42 patients who did not die during their hospitalization following mechanical thrombectomy for pulmonary embolism. Calculation of odds ratios was performed with 95% confidence intervals for mortality outcomes.

Results: For the overall dataset, the average age was 59.5 (SD=16.3) and percentage female was 47.7% (n=159). The analysis revealed that patients in the Midwest had a significantly longer mean hospital stay compared to other regions (10.91 days, SD=23.2, F-Value=4.23, p=0.04). Additionally, obesity was associated with a lower odds of mortality (OR=0.364, 95% CI: 0.140 - 0.947). Race, hospital location, hospital setting, and insurance type, did not show statistically significant differences in length of stay or mortality outcomes.

Conclusion: The findings indicate that Midwest region hospitals significantly increase the length of hospital stay following mechanical thrombectomy for pulmonary embolisms. Additionally, obesity may offer a protective effect against mortality, which is consistent with previous published literature for mortality of patients with pulmonary embolisms following medical intervention {1}. Further research is warranted to explore the underlying mechanisms driving these associations. Additionally, these results underscore that, regardless of socioeconomic and racial factors, patients are experiencing similar levels of mortality following mechanical thrombectomies.