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Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension
Chronic thromboembolic pulmonary hypertension is considered as a rare but severe complication after acute pulmonary embolism and is potentially curable by pulmonary endarterectomy. We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of pulmonary endarterectomy in chroni...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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SAGE Publications
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108078/ https://www.ncbi.nlm.nih.gov/pubmed/33996027 http://dx.doi.org/10.1177/20458940211008069 |
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author | Hobohm, Lukas Keller, Karsten Münzel, Thomas Konstantinides, Stavros V. Lankeit, Mareike |
author_facet | Hobohm, Lukas Keller, Karsten Münzel, Thomas Konstantinides, Stavros V. Lankeit, Mareike |
author_sort | Hobohm, Lukas |
collection | PubMed |
description | Chronic thromboembolic pulmonary hypertension is considered as a rare but severe complication after acute pulmonary embolism and is potentially curable by pulmonary endarterectomy. We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension patients and to investigate predictors of the in-hospital course. We analyzed data on the characteristics, comorbidities, treatments, and in-hospital outcomes for all chronic thromboembolic pulmonary hypertension patients treated with pulmonary endarterectomy in the German nationwide inpatient sample between 2006 and 2016. Overall, 1398 inpatients were included. Annual number of pulmonary endarterectomy increased from 67 in 2006 to 194 in 2016 (P < 0.001), in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; P < 0.001). Patients’ characteristics shifted slightly toward older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age (OR 1.03 (95%CI: 1.01–1.05); P = 0.001), right heart failure (2.55 (1.37–4.76); P = 0.003), in-hospital complications such as ischemic stroke (6.87 (1.06–44.70); P = 0.044) and bleeding events like hemopneumothorax (24.93 (6.18–100.57); P < 0.001). Annual pulmonary endarterectomy volumes per center below 10 annual procedures were associated with higher rates of adverse in-hospital outcomes. Annual numbers of chronic thromboembolic pulmonary hypertension patients treated with pulmonary endarterectomy increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings suggest that perioperative management of pulmonary endarterectomy, institutional experience, and patient selection is crucial and has improved over time. |
format | Online Article Text |
id | pubmed-8108078 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-81080782021-05-14 Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension Hobohm, Lukas Keller, Karsten Münzel, Thomas Konstantinides, Stavros V. Lankeit, Mareike Pulm Circ Original Research Article Chronic thromboembolic pulmonary hypertension is considered as a rare but severe complication after acute pulmonary embolism and is potentially curable by pulmonary endarterectomy. We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension patients and to investigate predictors of the in-hospital course. We analyzed data on the characteristics, comorbidities, treatments, and in-hospital outcomes for all chronic thromboembolic pulmonary hypertension patients treated with pulmonary endarterectomy in the German nationwide inpatient sample between 2006 and 2016. Overall, 1398 inpatients were included. Annual number of pulmonary endarterectomy increased from 67 in 2006 to 194 in 2016 (P < 0.001), in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; P < 0.001). Patients’ characteristics shifted slightly toward older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age (OR 1.03 (95%CI: 1.01–1.05); P = 0.001), right heart failure (2.55 (1.37–4.76); P = 0.003), in-hospital complications such as ischemic stroke (6.87 (1.06–44.70); P = 0.044) and bleeding events like hemopneumothorax (24.93 (6.18–100.57); P < 0.001). Annual pulmonary endarterectomy volumes per center below 10 annual procedures were associated with higher rates of adverse in-hospital outcomes. Annual numbers of chronic thromboembolic pulmonary hypertension patients treated with pulmonary endarterectomy increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings suggest that perioperative management of pulmonary endarterectomy, institutional experience, and patient selection is crucial and has improved over time. SAGE Publications 2021-04-28 /pmc/articles/PMC8108078/ /pubmed/33996027 http://dx.doi.org/10.1177/20458940211008069 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Article Hobohm, Lukas Keller, Karsten Münzel, Thomas Konstantinides, Stavros V. Lankeit, Mareike Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension |
title | Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension |
title_full | Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension |
title_fullStr | Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension |
title_full_unstemmed | Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension |
title_short | Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension |
title_sort | time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108078/ https://www.ncbi.nlm.nih.gov/pubmed/33996027 http://dx.doi.org/10.1177/20458940211008069 |
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