Detection of Pulmonary Embolism in the Postoperative Orthopedic Patient Using Spiral CT Scans

Abstract

Orthopedic surgery is associated with a significant risk of postoperative pulmonary embolism (PE) and/or deep vein thrombosis (DVT). This study was performed to compare the clinical presentations of a suspected versus a documented PE/DVT and to determine the actual incidence of PE/DVT in the post-operative orthopedic patient in whom CT was ordered. All 695 patients at our institution who had a postoperative spiral CT to rule out PE/DVT from March 2004 to February 2006 were evaluated and information regarding their surgical procedure, risk factors, presenting symptoms, location of PE/DVT, and anticoagulation were assessed. Statistical analysis was performed using an independent samples t test with a two-tailed p value to examine significant associations between the patient variables and CT scans positive for PE. Logistic regression models were used to determine which variables appeared to be significant predictors of a positive chest CT. Of 32,854 patients admitted for same day surgery across all services, 695 (2.1%) had a postoperative spiral CT based on specific clinical guidelines. The incidence of a positive scan was 27.8% (193/695). Of these, 155 (22.3%) scans were positive for PE only, 24 (3.5%) for PE and DVT, and 14 (2.0%) for DVT only. The most common presenting symptoms were tachycardia (56%, 393/695), low oxygen saturation (48%, 336/695), and shortness of breath (19.6%, 136/695). Symptoms significantly associated with DVT were syncope and chest pain. A past medical history of PE/DVT was the only significant predictor of a positive scan. Patients who have a history of thromboembolic disease should be carefully monitored in the postoperative setting.

Simultaneous Bilateral Total Knee Arthroplasty Becomes Safer after Institution of Optimal Perioperative Management: A Longitudinal Cohort Study

“…29 Blood loss resulting in anemia may produce hypotension, weakness, and loss of balance with heightened risks of transfusion-related lung injury, immune sensitization, disease transmission, and thromboembolism. [12][13][14]30 Although spiral computed tomography allows for direct visualization of pulmonary vasculature to detect compounding PE reliably with a high specificity of 81 to 100%, 31 the routine use of prolonged anticoagulation may lead to unnecessary treatment of isolated subsegmental clots with morbidity. At our institution, the common symptoms of tachycardia, shortness of breath, and a low O 2 saturation (<90%)together with a history of PE/DVT and a BMI of >30 kg/m 2 were associated with a positive detection of life-threatening events.…”

Current concepts in deep vein thrombosis and pulmonary embolism after trauma

“…In a review of 695 patients, Kim et al 7 found a 27.8% rate of positive computed tomographic pulmonary angiography (CTPA) results for PE in postoperative orthopaedic patients. It often is subtle, atypical, or even silent.…”

Deep Vein Thrombosis Prophylaxis in Orthopedic Surgery

“…As such, the implementation of effective prophylaxis against DVT assumes paramount importance in mitigating the risk of VTE complications. A multitude of guidelines and recommendations have been established to assist clinicians in selecting the most appropriate prophylactic approach, accounting for factors such as individual patient risk, the nature of the surgical procedure, and other pertinent clinical considerations [ 14 ]. Among these recommendations, the American College of Chest Physicians advises the use of mechanical prophylaxis methods, including graduated compression stockings (GCS), intermittent pneumatic compression (IPC), or a combination of mechanical and pharmacological approaches for patients at high risk of DVT [ 15 ].…”