The effect of COVID-19 pandemic on admission, management and mortality of pulmonary embolism in cancer patients

Background: Pulmonary embolism (PE) is a leading cause of morbidity among cancer patients. The COVID-19 pandemic introduced new challenges to healthcare delivery. This study aimed to evaluate the impact of the COVID-19 pandemic on PE-related hospitalizations, treatment, and in-hospital outcomes in patients with active cancer. Methods: We conducted a retrospective analysis using the National Inpatient Sample database from 2016 to 2021. Patients with active cancer and a primary diagnosis of acute PE were categorized into three groups: pre-COVID-19 (2016-2019), peak COVID-19 (2020), and ongoing COVID-19 (2021). We compared baseline characteristics, in-hospital procedures, and clinical outcomes among these groups. Multivariable logistic regression was employed to assess associations between COVID-19 periods and outcomes. Results: Among 170,630 patients with PE and cancer, admission rates decreased during the pandemic. Patients hospitalized during the COVID-19 pandemic more frequently presented with severe PE phenotypes, including saddle PE (9.7 % and 9.4 % vs. 7.5 %, p < 0.001) and acute cor pulmonale (8.4 % and 8.9 % vs. 5.9 %, p < 0.001). Thrombolysis-based therapies increased during the pandemic, whereas adjusted odds of catheter-directed embolectomy were lower. Despite more severe presentations, in-hospital mortality remained relatively stable (6.0 % pre-COVID-19, 6.0 % peak, 5.5 % ongoing; p = 0.004). Conclusion: The COVID-19 pandemic led to decreased PE-related hospitalizations among cancer patients but was associated with more severe presentations and shifts in therapeutic strategies. Notably, in-hospital mortality remained stable, which may be consistent with maintained PE care pathways during the pandemic. These findings highlight the need for robust, adaptable healthcare systems to ensure continuity of care for high-risk populations during global health crises.