How patient profile and hospital setting drive pulmonary embolism treatment modality.

objectiveThis study aimed to evaluate how the choice of intervention modality for pulmonary embolism (PE) is influenced by patient and hospital characteristics. We compared catheter-directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), and surgical embolectomy.

methodsUtilizing the Maryland statewide database from the Health Services Cost Review Commission (HSCRC), we analyzed interventions for PE over a 6-year period (fiscal years 2019-2024), focusing on CDT, PMT, and surgical embolectomy. Key hospital factors, including trauma center status, hospital size, Leapfrog safety ratings, extracorporeal membrane oxygenation (ECMO) availability, and PE volume, were assessed for their association with intervention choice. Patient characteristics were assessed for their association with intervention choice including demographics, comorbidities, and health insurance status. Univariate and multivariate statistics were performed to assess the relationship between patient and hospital characteristics and PE interventions.

resultsOver time the utilization of PMT increased with a concomitant decrease in utilization of CDT. CDT was more commonly performed in trauma centers, smaller hospitals, Leapfrog B to D rated hospitals, and hospitals with lower PE volumes. In contrast, PMT was more frequently performed in non-trauma centers, non-ECMO programs, larger hospitals, Leapfrog A rated hospitals, and hospitals with higher PE volumes. Surgical embolectomy was primarily performed in high-volume centers equipped with cardiac surgery and ECMO capabilities. African American patients and those with higher social vulnerability index were more likely to undergo CDT. Comorbidity profiles increased progressively from CDT to PMT to surgical embolectomy. Surgical embolectomy patients were generally younger and more likely to be on Medicaid, whereas PMT/CDT patients were more commonly covered by Medicare. Patients undergoing surgery had higher rates of transfer from other facilities. There were no significant differences in rates of non-routine discharge or mortality across the interventions. In the multivariate model, presence of a cardiac surgery program was associated with increased odds of PMT.

conclusionsPMT has been adopted at a higher rate than CDT in Maryland over the past 6 years, potentially due to benefits such as reduced length of stay and intensive care unit requirements. Our findings demonstrate that both patient and hospital characteristics influence the modality of PE intervention. These results highlight significant disparities based on race, social vulnerability, and hospital characteristics that warrant systemic attention.