Authors:	Hobohm, Lukas Keller, Karsten Münzel, Thomas Konstantinides, Stavros V. Lankeit, Mareike
Title:	Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension
Online publication date:	10-Sep-2021
Year of first publication:	2021
Language:	english
Abstract:	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.
DDC:	610 Medizin 610 Medical sciences
Institution:	Johannes Gutenberg-Universität Mainz
Department:	FB 04 Medizin
Place:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-6324
Version:	Published version
Publication type:	Zeitschriftenaufsatz
Document type specification:	Scientific article
License:	CC BY-NC
Information on rights of use:	https://creativecommons.org/licenses/by-nc/4.0/
Journal:	Pulmonary circulation 11 2
Pages or article number:	20458940211008069
Publisher:	Sage Publications
Publisher place:	Thousand Oaks, CA
Issue date:	2021
ISSN:	2045-8940
Publisher URL:	https://doi.org/10.1177/20458940211008069
Publisher DOI:	10.1177/20458940211008069
Appears in collections:	JGU-Publikationen