Postoperative Pulmonary Embolism Including Asymptomatic Cases in Gynecologic Oncology

Okadome, Masao; Saito, Toshiaki; Miyahara, Daisuke; Yamanaka, T.; Kuroiwa, Toshiro; Kurihara, Yujiro

doi:10.1111/igc.0b013e3181bdbeb5

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…6,16 In our previous study, which included the period before methodical prophylaxis was established, the overall incidence of postoperative PE was 2.14%; according to univariate analysis, the incidence was higher in women with malignant diseases than in women with benign diseases. 3 However, in the present study, the incidence of postoperative PE did not statistically differ between women with malignant diseases and those with benign diseases, although the mean age was significantly older and the mean operation time was significantly longer among women with malignant diseases. The rate of anticoagulant use and the rate of D-dimer measurement were both significantly higher among women with malignant diseases compared with those with benign diseases.…”

Section: Discussioncontrasting

confidence: 73%

“…2 Following gynecologic surgeries, another study found that 35.6% of women diagnosed with postoperative PE were asymptomatic and had no signs except for a low oxygen saturation as measured by pulse oximetry (SpO 2 ) level. 3 The PE was mainly diagnosed by lung scan in these studies, [1][2][3] and subsegmental PE cases were hard to precisely diagnose.…”

Section: Introductionmentioning

confidence: 99%

“…4 In our previous study, 51.1% of PE cases occurring after gynecologic surgeries were detected on postoperative days 1 and 2; 70.4% of patients were asymptomatic and had no signs except for a drop in SpO 2 . 3 However, the importance of identifying PE that occurs just after surgery is not clear, because few studies have assessed whether cases of asymptomatic PE in the early postoperative phase are subsegmental versus more proximal. In this study, we investigated the location of, and symptoms and signs associated with, PE diagnosed on postoperative days 1 and 2, and we also investigated the background characteristics of women who were diagnosed with postoperative PE within 2 months after surgery.…”

Section: Introductionmentioning

confidence: 99%

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Early Identification of Asymptomatic Pulmonary Embolism Proximal to the Subsegmental Arteries After Gynecologic Surgery

Okadome

Saito

Shimamoto

et al. 2015

Clin Appl Thromb Hemost

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Few studies have assessed whether cases of asymptomatic pulmonary embolism (PE) in the early postoperative phase are subsegmental versus more proximal. In this study, we investigated whether asymptomatic PE occurring just after gynecologic surgery was subsegmental, and we examined the background characteristics of patients who experienced PE within 2 months postoperatively. All hospital records were reviewed, yielding a total of 2052 women who had undergone surgeries performed by the gynecologic oncology team between 2003 and 2013 in the National Kyushu Cancer Center. Asymptomatic and symptomatic postoperative PE cases diagnosed by multidetector computed tomography angiography or lung scan were identified; after excluding 2 cases of preoperative PE, there were 15 (0.73%) cases of postoperative PE among 2050 women. Of the 15 cases, 9 (60%) were diagnosed on postoperative day 1 or 2. Of the 9 women, 4 had no or minor symptoms/signs other than decreased oxygen saturation as measured by pulse oximetry (SpO 2 ), and PE was segmental or more proximal in 3 cases. Only 1 of the 9 cases showed dyspnea. The remaining 4 cases showed dizziness or perspiration, suggesting PE. Univariate analysis showed age, operation time, hypertension, and preoperative D-dimer elevation to be associated with postoperative PE. Multivariate analysis demonstrated that a high (!1 mg/mL) preoperative D-dimer level was associated with postoperative PE (odds ratio, 6.331; 95% confidence interval, 1.567-25.589). Most asymptomatic PE cases occurring within 2 days postoperatively were segmental or more proximal. Identification of early, asymptomatic postoperative PE may be clinically significant because most of these emboli are proximal to the subsegmental arteries.

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Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early Identification of Asymptomatic Pulmonary Embolism Proximal to the Subsegmental Arteries After Gynecologic Surgery

Okadome

Saito

Shimamoto

et al. 2015

Clin Appl Thromb Hemost

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“…Using computed tomography pulmonary angiography (CTPA), which has better spatial resolution and diagnostic accuracy than a ventilation-perfusion (V/Q) scan, small (asymptomatic) perfusion defects can be detected more accurately [40, 41]. If these perfusion defects are taken into account, the incidence of asymptomatic PE after non-cardiac surgery is expected to exceed 4 % [37, 42, 43]. However, the clinical relevance of small—mostly asymptomatic - perfusion defects has not yet been fully determined [44].…”

Section: Literaturementioning

confidence: 99%

The aetiology of myocardial injury after non-cardiac surgery

et al. 2013

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Recognition of myocardial injury after non-cardiac surgery is difficult, since strong analgesics (e.g. opioids) can mask anginal symptoms, and ECG abnormalities are subtle or transient. Thorough knowledge of the pathophysiological mechanisms is therefore essential. These mechanisms can be subdivided into four groups: type I myocardial infraction (MI), type II MI, non-ischaemic cardiac pathology, and non-cardiac pathology. The incidence of type I MI in patients with a clinical suspicion of perioperative acute coronary syndrome (ACS) is 45–57 %. This percentage is higher in patients with a high likelihood of MI such as patients with ST-elevation ACS. Of note, the generalisability of this statement is limited due to significant study limitations. Non-ischaemic cardiac pathology and non-cardiac pathology should not be overlooked as a cause of perioperative myocardial injury (PMI). Especially pulmonary embolism and dysrhythmias are a common phenomenon, and may convey important prognostic value. Implementation of routine postoperative troponin assessment and accessible use of minimally invasive imaging should be considered to provide adequate individualised therapy. Also, addition of preoperative imaging may improve the stratification of high-risk patients who may benefit from preoperative or perioperative interventions.

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“…Rates are higher in ovarian cancer and with prolonged or complicated surgeries, but are still generally below 10%. Risk of PE also increases with age over 60 years and every BMI increase of 5 kg/m 2 [11]. Treatment of VTE includes hemodynamic support, supplemental oxygen and therapeutic levels of anticoagulation within 24 h. In acute PE, thrombolytic therapy and/or intubation may be initiated.…”

Section: Venous Thromboembolismmentioning

confidence: 99%

Unintended Consequences: Surgical Complications in Gynecologic Cancer

Horvath

George

Herzog

2013

Womens Health (Lond Engl)

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More than 91,000 women in the USA will be diagnosed with a gynecologic malignancy in 2013. Most will undergo surgery for staging, treatment or both. No therapeutic intervention is without consequence, therefore, it is imperative to understand the possible complications associated with the perioperative period before undertaking surgery. Complication rates are affected by a patient population that is increasingly older, more obese and more medically complicated. Surgical modalities consist of abdominal, vaginal, laparoscopic and robotic-assisted approaches, and also affect rates of complications. An understanding of the various approaches, patient characteristics and surgeon experience allow for individualized decision-making to minimize the complications after surgery for gynecologic cancer.

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Postoperative Pulmonary Embolism Including Asymptomatic Cases in Gynecologic Oncology

Cited by 7 publications

References 27 publications

Early Identification of Asymptomatic Pulmonary Embolism Proximal to the Subsegmental Arteries After Gynecologic Surgery

Early Identification of Asymptomatic Pulmonary Embolism Proximal to the Subsegmental Arteries After Gynecologic Surgery

The aetiology of myocardial injury after non-cardiac surgery

Unintended Consequences: Surgical Complications in Gynecologic Cancer

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