Emergency surgery after pulmonary embolism: fewer adverse events beyond 60 days

Design

Retrospective cohort, US Nationwide Readmissions Database 2016 to 2022

Population

3,785 adults having emergency general surgery after acute pulmonary embolism

Primary outcome

Major adverse events

Effect

Surgery after 60 days vs within 60 days: adjusted OR 0.45 (0.37 to 0.55)

This retrospective study used the US Nationwide Readmissions Database from 2016 to 2022. Of 1,309,175 hospitalisations for acute pulmonary embolism, 3,785 patients went on to emergency general surgery within the same calendar year. Modelling time from discharge to operation showed an inflection in major adverse events at 60 days; just over half were operated on before that point.

Compared with surgery within 60 days, later surgery was associated with lower odds of major adverse events (adjusted OR 0.45, 95% CI 0.37 to 0.55) and fewer thromboembolic, cardiac and respiratory complications, readmissions and resource use. The pattern held across operative risk groups and for both open and laparoscopic operations.

Emergency surgery often cannot wait, and nothing here suggests delaying an operation a patient needs now. The finding matters for the many 'emergency' operations with some latitude: recurrent biliary colic, a settled diverticulitis, an incarcerated hernia that has reduced. For those, the timing of a recent pulmonary embolism deserves to be part of the decision, along with anticoagulation planning and the input of the physician managing the clot.

• Ask about pulmonary embolism in the past two months before any emergency general surgery.
• Where the operation can safely wait, consider deferring it beyond 60 days after the embolism.
• Plan perioperative anticoagulation with the team managing the embolism before booking theatre.
• Do not delay surgery that is needed now; the study cannot show that waiting is safe for an acute abdomen.
• Warn patients operated on within 60 days of an embolism that their complication risk is higher.

Why it matters

A recent pulmonary embolism is a timing question for the surgeon, not only an anticoagulation question.

Don't overread it

This is observational database work; it cannot show that delaying a given operation would have prevented its complications.

The statistics, in plain English

An adjusted odds ratio of 0.45 means less than half the odds of a major adverse event with later surgery, and the interval stays well below 1.0. But patients who could wait were probably less sick, and an administrative database cannot fully capture how urgent each operation was, so part of this difference is selection rather than timing.

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