Incidence Rates of Postoperative Pulmonary Embolisms in Symptomatic and Asymptomatic Patients, Detected by Diagnostic Images　― A Single-Center Retrospective Study ―

Abstract

Background: Pulmonary embolism (PE) is a serious complication during the perioperative period. However, because most previous studies on the incidence of postoperative PE are based on symptoms, asymptomatic occurrences of PE have been overlooked, and the absolute incidence of postoperative PE remains unknown. The aim of this study was to investigate the incidence of perioperative PE, regardless of its symptoms, by reviewing the clinical interpretations of the diagnostic images obtained during the postoperative period. Methods and Results: This study included all patients aged at least 18 years who underwent operations under general and/or neuraxial anesthesia in our institution from 2013 to 2016. We reviewed all interpretations of the diagnostic imaging performed in the postoperative period. We analyzed the 90-day cumulative incidence of postoperative PE and the characteristics, risk factors, and symptoms of patients with and without postoperative PE. Among 21,763 operations, postoperative diagnostic imaging was performed in 1,168 patients, which found PE in 217 patients. Symptoms appeared in 11.1% (24/217) of the PE patients, and 66.7% of these symptoms were decreased levels of SpO2 alone. Mortality from PE was 0.5% (1/217). Conclusions: Diagnostic imaging found a number of postoperative PE cases, regardless of the presence of symptoms. Although symptomatic PE was not a frequent occurrence, these findings suggest that clinicians should be aware of postoperative PE even under current prophylaxis.

Postoperative pulmonary complications in noncardiothoracic surgery

“…Pulmonary embolism (PE) is a rare but potentially fatal complication of surgery. The rate of PE in our study was 2%, relatively lower than other studies [10,11]. Matsuoka et al [10] investigated the risk factors for postoperative PE.…”

Efficacy and safety of short-term (3 days) enoxaparin in preventing venous thromboembolism after gastric cancer surgery: A single-center, prospective cohort study

“…Cancer-associated thrombosis is now widely recognized as a major complication in cancer patients, with a cancer-associated VTE incidence as high as 27% in the general population [16]. The 90-day cumulative incidence of postoperative PE is surprisingly high, at 18.6% (217/1,168), including incidental findings in postoperative routine diagnostic imaging, regardless of symptoms [17]. The risk of VTE in cancer patients undergoing surgery is reportedly 3.7 times higher than that in non-cancer patients [18], which suggests that proper prophylaxis for VTE in the perioperative period is important, especially for cancer surgical patients.…”

Tromboembolismo pulmonar agudo en Santander

“…Adicionalmente, las características propias de la enfermedad dificultan su detección, debido a que algunos casos cursan sin evidencia de síntomas iniciales; por ejemplo, un metaanálisis encontró que la prevalencia de TEP incidental fue 2.6% (IC del 95%: 1.9; 3.4) (9). Por otro lado, su diagnóstico precisa un alto grado de sospecha clínica y pruebas especializadas, haciendo que los estudios poblacionales y de campo conlleven grandes dificultades operativas y costos elevados (3,10). Por todo ello, hay una limitada disponibilidad de información epidemiológica al respecto (3,8).…”