Risk Factors and Outcomes for Preoperative Asymptomatic Pulmonary Embolism in Patients Aged 60 Years and Over with Hip Fracture

Abstract

Objective To investigate the risk factors for, and outcomes of, preoperative asymptomatic pulmonary embolism (PE) in patients ≥60 years old following delayed operation for hip fracture. Methods From March 2017 to December 2018, 90 patients aged ≥60 years with hip fracture who suffered a delay in surgery were recruited to this prospective study following admission to our hospital. Computed tomography pulmonary angiography (CTPA) was used to detect preoperative asymptomatic PE and calculated its incidence. Time from injury to admission, baseline characteristics, medical comorbidities, and blood biomarker levels were evaluated as potential risk factors. Logistic regression analysis was used to identify risk factors. Mortality and major bleeding events were recorded and compared between individuals with PE and without. Data were analyzed by t‐test, Mann–Whitney U test, χ2 test, Fisher's exact test, and logistic regression analysis. Results The incidence of preoperative asymptomatic PE was 18.9% (17/90 patients). In the univariate analysis, the risk factors for preoperative asymptomatic PE were male sex, hypertension, cerebrovascular accident, smoking, plasma D‐dimer level, potassium level, urea level, creatinine level, and cysteine level. Multivariate logistic regression analysis showed that the risk of preoperative asymptomatic PE was higher in patients with hypertension (odds ratio [OR] = 10.048; 95% confidence interval [CI], 1.118–90.333), cerebrovascular accident (OR = 20.135; 95% CI, 1.875–216.164), smoking (OR = 48.741; 95% CI, 4.155–571.788), high plasma D‐dimer levels (OR = 1.200; 95% CI, 1.062–157.300), and high plasma potassium levels (OR = 12.928; 95% CI, 1.062–157.300). All patients were followed up for 21.0 months (range, 2 to 36 months). Mortality within the first year postoperatively was higher in patients with PE (29.41% vs 9.59%, P = 0.046). Conclusions In view of the high incidence of preoperative asymptomatic PE and the inferior prognosis in individuals with PE, routine CTPA examination for preoperative asymptomatic PE could be useful for patients aged ≥60 years with hip fracture for whom surgery is delayed.

Low Mean Platelet Volume is Associated with Deep Vein Thrombosis in Older Patients with Hip Fracture

“… 18 – 22 Likewise, the incidence of asymptomatic and symptomatic PE was not low, reaching up to 18.9% and 0.2%, respectively. 23 , 24 After the development of VTE, length of stay and total cost increased approximately two-fold, 25 and significantly decreased patients’ survival rate. 24 …”

Pulmonary Embolism in Women: A Systematic Review of the Current Literature

“…Sex-specific long-term mortality data is limited in the current literature. However, studies show increased long-term mortality (median follow-up ranging 15 to 21 months) in patients who suffered a PE compared to those who did not [ 79 , 80 ]. Siddique et al evaluated long-term mortality after PE over a 10-year period and found men to have lower survival rates compared to women, although in both sexes, survival declined with advancing age [ 81 ].…”

Risk factors for patients with acute hospital-acquired symptomatic pulmonary thromboembolism

“…Approximately 3.1 million new cases are diagnosed in China every year, and this number has been increasing each year 15,16 . Depending on the severity of the embolism, both symptomatic and asymptomatic embolism can occur 17,18 . Acute SPE is a condition we must be on high alert for because it may be life-threatening 8 .…”