Perioperative rates of deep vein thrombosis and pulmonary embolism in normal weight vs obese and morbidly obese surgical patients in the era post venous thromboembolism prophylaxis guidelines

Wang, Lily; Pryor, Aurora D.; Altieri, Maria S.; Romeiser, Jamie; Talamini, Mark A.; Shroyer, A. Laurie; Telem, Dana A.

doi:10.1016/j.amjsurg.2015.01.021

Cited by 17 publications

(12 citation statements)

References 26 publications

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“…The National Surgical Quality Improvement Program reported a 0.3-0.6% incidence rate. 4,22 Even after hip and knee arthroplasty, which are one of the highest risk procedures, incidence rates of symptomatic PE were reported as 0.14-0.27% under recommended prophylaxis. 23 These symptom-based studies inevitably underestimate the incidence of PE.…”

Section: Discussionmentioning

confidence: 99%

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

Matsuoka

Morimatsu

2019

Circ J

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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.

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Section: Discussionmentioning

confidence: 99%

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

Matsuoka

Morimatsu

2019

Circ J

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“…In comparison, the incidence of pneumonia in the PEDUCAT trial, below 9%, is rather low, even though 2.9% of the patients included in this trial underwent esophagectomy. According to a current retrospective cohort analysis evaluating a total of 33,325 patients undergoing abdominal surgery, DVT and pulmonary embolism occur in less than 1% of patients [ 18 ]. The authors attribute the low frequencies to improvements in prophylaxis adherence.…”

Section: Discussionmentioning

confidence: 99%

Impact of preoperative patient education on the prevention of postoperative complications after major visceral surgery: the cluster randomized controlled PEDUCAT trial

Klaiber

Stephan-Paulsen

Brückner

et al. 2018

Trials

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BackgroundThe prevention of postoperative complications is of prime importance after complex elective abdominal operations. Preoperative patient education may prevent postoperative complications and improve patients’ wellbeing, but evidence for its efficacy is poor. The aims of the PEDUCAT trial were (a) to assess the impact of preoperative patient education on postoperative complications and patient-reported outcomes in patients scheduled for elective complex visceral surgery and (b) to evaluate the feasibility of cluster randomization in this setting.MethodsAdult patients (age ≥ 18 years) scheduled for elective major visceral surgery were randomly assigned in clusters to attend a preoperative education seminar or to the control group receiving the department’s standard care. Outcome measures were the postoperative complications pneumonia, deep vein thrombosis (DVT), pulmonary embolism, burst abdomen, and in-hospital fall, together with patient-reported outcomes (postoperative pain, anxiety and depression, patient satisfaction, quality of life), length of hospital stay (LOS), and postoperative mortality within 30 days after the index operation. Statistical analysis was primarily by intention to treat.ResultsIn total 244 patients (60 clusters) were finally included (intervention group 138 patients; control group 106 patients). Allocation of hospital wards instead of individual patients facilitated study conduct and reduced confusion about group assignment. In the intervention and control groups respectively, pneumonia occurred in 7.4% versus 8.3% (p = 0.807), pulmonary embolism in 1.6% versus 1.0% (p = 0.707), burst abdomen in 4.2% versus 1.0% (p = 0.165), and in-hospital falls in 0.0% versus 4.2% of patients (p = 0.024). DVT did not occur in any of the patients. Mortality rates (1.4% versus 1.9%, p = 0.790) and LOS (14.2 (+/− 12.0) days versus 16.1 (+/− 15.0) days, p = 0.285) were also similar in the intervention and control groups.ConclusionsCluster randomization was feasible in the setting of preoperative patient education and reduced the risk of contamination effects. The results of this trial indicate good postoperative outcomes in patients undergoing major visceral surgery without superiority of preoperative patient education compared to standard patient care at a high-volume center. However, preoperative patient education is a helpful instrument not only for teaching patients but also for training the nursing staff.Trial registrationGerman Clinical Trials Registry, DRKS00004226. Registered on 23 October 2012. Registered 8 days after the first enrollment.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2676-6) contains supplementary material, which is available to authorized users.

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“…Obesity is recognized as an independent risk factor for perioperative venous thromboembolism (VTE) [29][30][31][32][33][34]. Recent ACS-NSQIP database analysis finds that a BMI at least 40 kg/m 2 significantly increased the odds of VTE after CABG, total hip arthroplasty, colectomy, prostatectomy, and pancreatectomy [6 && ].…”

Section: Thromboembolic Complicationsmentioning

confidence: 99%

Morbid obesity and perioperative complications

Tsai

Schumann

2016

Current Opinion in Anaesthesiology

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Perioperative rates of deep vein thrombosis and pulmonary embolism in normal weight vs obese and morbidly obese surgical patients in the era post venous thromboembolism prophylaxis guidelines

Cited by 17 publications

References 26 publications

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

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

Impact of preoperative patient education on the prevention of postoperative complications after major visceral surgery: the cluster randomized controlled PEDUCAT trial

Morbid obesity and perioperative complications

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Perioperative rates of deep vein thrombosis and pulmonary embolism in normal weight vs obese and morbidly obese surgical patients in the era post venous thromboembolism prophylaxis guidelines

Cited by 17 publications

References 26 publications

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

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

Impact of preoperative patient education on the prevention of postoperative complications after major visceral surgery: the cluster randomized controlled PEDUCAT trial

Morbid obesity and perioperative complications

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

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