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Keywords:

  • immobilization;
  • mortality;
  • pulmonary embolism;
  • risk factors;
  • surgery

Summary.  Background:  The influence of recent immobilization or surgery on mortality in patients with pulmonary embolism (PE) is not well known.

Methods:  We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) data to compare the 3-month mortality rate in patients with PE, with patients categorized according to the presence of recent immobilization, recent surgery, or neither.

Results:  Of 18 028 patients with PE, 4169 (23%) had recent immobilization, 2212 (12%) had recent surgery, and 11 647 (65%) had neither. The all-cause mortality was 10.0% (95% confidence interval [CI] 9.5–10.4), and the PE-related mortality was 2.6% (95% CI 2.4–2.9). One in every two patients who died from PE had recent immobilization (43%) or recent surgery (6.7%). Only 25% of patients with immobilization had received prophylaxis, as compared with 65% of the surgical patients. Fatal PE was more common in patients with recent immobilization (4.9%; 95% CI 4.3–5.6) than in those with surgery (1.4%; 95% CI 1.0–2.0) or those with neither (2.1%; 95% CI 1.8–2.3). On multivariate analysis, patients with immobilization were at increased risk for fatal PE (odds ratio 2.2; 95% CI 1.8–2.7), with no differences being seen between patients immobilized in hospital or in the community.

Conclusions:  Forty-three per cent of patients dying from PE had recent immobilization for ≥ 4 days. Many of these deaths could have been prevented.