Timing of Emergency General Surgery After Acute Pulmonary Embolism

The optimal timing of emergency general surgery (EGS) after acute pulmonary embolism (PE) is uncertain, and elective noncardiac surgery guidelines provide limited guidance for this high-acuity population.

Adults hospitalized with a principal diagnosis of acute PE who subsequently underwent EGS were identified in the 2016-2022 Nationwide Readmissions Database. Time from PE discharge to EGS was modeled using restricted cubic splines. Major adverse events (MAE), complications, readmission, and resource use were evaluated across operative risk and open/laparoscopic approach subgroups.

Among 1,309,175 acute PE hospitalizations, 3,785 (0.3%) underwent subsequent EGS within the calendar year of index hospitalization. Risk-adjusted analysis identified a 60-day inflection point for MAE; 52.4% underwent EGS within 60 days and were classified as Early, with remaining patients classified as Delayed. Compared with Early, Delayed EGS was associated with lower odds of MAE (adjusted odds ratio [OR] 0.45; 95% CI 0.37-0.55) and lower rates of thromboembolic, cardiac, and respiratory complications, readmission, and resource use. This association persisted across operative risk categories and surgical approaches.

EGS performed at least 60 days after acute PE was associated with fewer adverse events and lower resource use. When clinically feasible, timing after PE may be an important consideration in planning EGS.