Postoperative pulmonary embolism: timing, diagnosis, treatment, and outcomes

Hope, William W.; Demeter, Bradley L.; Newcomb, William L.; Schmelzer, Thomas M.; Schiffern, Lynnette; Heniford, B. Todd; Sing, Ronald F.

doi:10.1016/j.amjsurg.2007.08.014

Cited by 28 publications

(18 citation statements)

References 27 publications

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“…In 2006, Bjørnarå et al reported that pulmonary emboli occurred at a median of 12 days following major joint arthroplasty [10]. In 2007, Hope et al found that the timing of PE varied significantly with the age of the patients: in patients younger than the age of 40 years, the majority of PEs occurred around day 3; however, in patients between the ages of 40 to 60 years, PEs tended to occur later, around day 11 [11]. Current ACCP guidelines recommend pharmacologic anticoagulation for TKA and THA for a minimum of 10 to 14 days, and up to 35 days [12].…”

mentioning

confidence: 95%

“…Regardless of the specific pharmacologic agent employed, the risk of its use can be decreased by minimizing its administration to the shortest time postoperatively that is necessary to provide a therapeutic benefit. Studies have found that the vast majority of cases of pulmonary embolism (PE) occur early in the postoperative course, suggesting that extended prophylaxis may not be warranted [10,11]. In 2006, Bjørnarå et al reported that pulmonary emboli occurred at a median of 12 days following major joint arthroplasty [10].…”

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confidence: 96%

See 1 more Smart Citation

Timing of Symptomatic Pulmonary Embolism with Warfarin Following Arthroplasty

Parvızı

Huang

Raphael

et al. 2015

The Journal of Arthroplasty

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confidence: 95%

mentioning

confidence: 96%

Timing of Symptomatic Pulmonary Embolism with Warfarin Following Arthroplasty

Parvızı

Huang

Raphael

et al. 2015

The Journal of Arthroplasty

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“…Most series do not distinguish between emboli occurring during and after surgery, but Koessler et al reviewed 4 series of patients undergoing total hip arthroplasty and found that the incidence of symptomatic intraoperative PE was between 0.6% and 10% [10]. Mortality associated with perioperative PE is as high as 12.9% in patients presenting for hip fracture repair [4,11]. However, both Kerkez et al and Milbrink and Bergqvist recently found a much lower incidence of symptomatic emboli, approximately 0.25%, in patients receiving thromboembolism prophylaxis following hip fracture surgery [7,12].…”

Section: Incidence In Surgical Patientsmentioning

confidence: 99%

Perioperative pulmonary embolism: diagnosis and anesthetic management

Desciak¹,

Martin²

2011

Journal of Clinical Anesthesia

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“…For instance, thoracic complaints may be misinterpreted in the presence of post-operative pain whereas dyspnoea and low oxygen saturation may be attributed to post-operative anaemia. 6 As some PEs may consequently have been missed, the incidence of PE after EVAR could be underestimated.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Embolism After Endovascular Aortic Repair, a Retrospective Cohort Study

Grobben

Frima

Nathoe

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS This is the first study to assess pulmonary embolism after endovascular aortic repair using routinely performed aortic computed tomography angiographiess. This paper shows that, despite routine thrombo-embolism prophylaxis, pulmonary embolism occurs frequently after endovascular aortic repair, and thoracic endovascular aortic repair, respectively.Objectives: Endovascular aortic repair (EVAR) is associated with an increased risk of pulmonary embolism, which is often clinically silent and therefore difficult to recognise. The aim was to investigate the incidence of pulmonary embolism after EVAR using routinely performed pre-and post-operative aortic computed tomography angiography (CTA), and the association between pulmonary embolism and mortality. Methods: This single centre retrospective cohort study included adult patients who underwent EVAR in the University Medical Centre Utrecht between January 2010 and July 2015 and who had a total aortic, thoracic aortic, or pulmonary CTA within one month post-operatively. Baseline and mortality data were obtained by reviewing hospital and general practitioner records. The primary outcome was pulmonary embolism within one month after surgery. Secondary outcomes were 30 day and six month mortality. Results: During the study period, 526 EVARs were performed. Seventy-four of these procedures were included in the analysis of which there were 40 thoracic and 34 abdominal EVARs. In nine patients (12%, 95% CI 7e22) pulmonary embolism was observed of which one was central, two were segmental, and six were subsegmental. Seven were clinically silent and two were present on the pre-operative CTA. Thirty day mortality was significantly higher in patients with pulmonary embolism (relative risk 14.4, 95% CI 1.4e143, p ¼ .037) though none of the deaths seemed directly attributable to it. Conclusions: This study, although preliminary, suggests that silent pulmonary embolism after EVAR occurs in approximately one in 10 patients, despite routine thrombo-embolism prophylaxis. Pulmonary embolism was associated with a higher 30 day mortality risk yet it was not the cause of death in any of these patients.

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Postoperative pulmonary embolism: timing, diagnosis, treatment, and outcomes

Cited by 28 publications

References 27 publications

Timing of Symptomatic Pulmonary Embolism with Warfarin Following Arthroplasty

Timing of Symptomatic Pulmonary Embolism with Warfarin Following Arthroplasty

Perioperative pulmonary embolism: diagnosis and anesthetic management

Pulmonary Embolism After Endovascular Aortic Repair, a Retrospective Cohort Study

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