Abstract Introduction Mechanical thrombectomy (MT) for pulmonary embolism (PE) has increased in prevalence over recent years. Understanding risks and benefits in high-risk populations undergoing MT is essential for improving outcomes. The Hospital Frailty Risk Score (HFRS) is a clinical measure reflecting a patient’s overall health status and vulnerability to adverse outcomes. Identifying predictors of outcomes in patients undergoing MT may help tailor therapy and improve survival. Methods This retrospective cohort study used data from the National Inpatient Sample (2019-2022) to identify hospitalizations in which patients underwent mechanical thrombectomy for PE (procedure code). Patients were stratified into low (LFI, 0-4), intermediate (IFI, 5-15), and high (HFI, ≥15) frailty groups based on the HFRS. The primary outcome was in-hospital mortality. Secondary outcomes included post-procedure complications (cardiac arrest, pneumothorax, cardiac tamponade, acute kidney injury, and shock), length of stay, and total hospitalization cost. Results A total of 36, 715 patients underwent MT for PE between 2019 and 2022. Of these, 54. 7% were classified as low frailty, 43. 0% as intermediate, and 2. 4% as high frailty. The mean HFRS for each group was 1. 9 (LFI), 8. 1 (IFI), and 17. 6 (HFI). Mean age increased with frailty: 59. 2 (LFI), 65. 5 (IFI), and 69. 6 (HFI) years. In-hospital mortality increased significantly with frailty (1. 5% LFI vs. 10. 5% IFI vs. 13. 4% HFI; p 0. 005). Adjusted odds ratios for mortality were 6. 97 (95% CI, 5. 1-9. 5) for IFI vs. LFI and 8. 0 (95% CI, 4. 5-14. 4) for HFI vs. LFI. Complication rates also rose with frailty (3. 6% LFI vs. 11. 0% IFI vs. 19. 7% HFI; p 0. 005). Mean length of stay increased with frailty (3. 8 vs. 7. 6 vs. 16. 1 days; p 0. 005), as did mean hospitalization cost (123, 089 vs. 201, 206 vs. 324, 746, respectively). Conclusion Patients with intermediate and high frailty experienced significantly higher mortality and complication rates after MT for PE compared with low-frailty patients. High-frailty patients had an approximately eightfold increased risk of mortality and nearly sixfold increased risk of procedural complications. Frailty was also associated with longer hospital stays and greater healthcare costs. As MT use for PE continues to rise, the HFRS offers a valuable tool for risk stratification and shared decision-making. Incorporating frailty assessment may improve patient selection, guide counseling on risk-benefit considerations, and align therapy with individual patient goals. This abstract is funded by: None
Vuchula et al. (2026) studied this question.