Symptomatic pulmonary embolism after outpatient arthroscopic procedures of the knee

Hetsroni, Iftach; Lyman, Stephen; Do, Huong; Mann, Gideon; Marx, Robert G.

doi:10.1302/0301-620x.93b1.25498

Cited by 73 publications

(53 citation statements)

References 25 publications

(25 reference statements)

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“…This statistical approach has made our findings robust to type I and II errors, although a methodological concern may be selection bias as only patients undergoing minor elective procedures were included. On the other hand, available epidemiological data obtained from over 400,000 knee arthroscopies (by far the most common procedure in this study) suggest that such patients reflect the general population, for example with regard to history of cancer and comorbidities [38]. In addition, the standardized sampling conditions in our operating rooms are likely to have benefitted the reliability of intersubject MA metabolite concentration comparisons.…”

Section: Discussionmentioning

confidence: 85%

Season of Sampling and Season of Birth Influence Serotonin Metabolite Levels in Human Cerebrospinal Fluid

et al. 2012

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BackgroundAnimal studies have revealed seasonal patterns in cerebrospinal fluid (CSF) monoamine (MA) turnover. In humans, no study had systematically assessed seasonal patterns in CSF MA turnover in a large set of healthy adults.Methodology/Principal FindingsStandardized amounts of CSF were prospectively collected from 223 healthy individuals undergoing spinal anesthesia for minor surgical procedures. The metabolites of serotonin (5-hydroxyindoleacetic acid, 5-HIAA), dopamine (homovanillic acid, HVA) and norepinephrine (3-methoxy-4-hydroxyphenylglycol, MPHG) were measured using high performance liquid chromatography (HPLC). Concentration measurements by sampling and birth dates were modeled using a non-linear quantile cosine function and locally weighted scatterplot smoothing (LOESS, span = 0.75). The cosine model showed a unimodal season of sampling 5-HIAA zenith in April and a nadir in October (p-value of the amplitude of the cosine = 0.00050), with predicted maximum (PCmax) and minimum (PCmin) concentrations of 173 and 108 nmol/L, respectively, implying a 60% increase from trough to peak. Season of birth showed a unimodal 5-HIAA zenith in May and a nadir in November (p = 0.00339; PCmax = 172 and PCmin = 126). The non-parametric LOESS showed a similar pattern to the cosine in both season of sampling and season of birth models, validating the cosine model. A final model including both sampling and birth months demonstrated that both sampling and birth seasons were independent predictors of 5-HIAA concentrations.ConclusionIn subjects without mental illness, 5-HT turnover shows circannual variation by season of sampling as well as season of birth, with peaks in spring and troughs in fall.

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Section: Discussionmentioning

confidence: 85%

Season of Sampling and Season of Birth Influence Serotonin Metabolite Levels in Human Cerebrospinal Fluid

et al. 2012

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“…In a series of 85 patients who underwent knee arthroscopy, Williams et al [53] found that 8.6% of the patients who possessed at least one classic risk factor were diagnosed with a clinically silent DVT compared with a rate of 1.6% in those who possessed no risk factors. Age has notably been documented as a risk factor for VTE after knee arthroscopy [16,29]; however, with the younger age at which trauma such as knee dislocations usually occurs, it is difficult to assess how this affects the risk of VTE in the multiligamentous knee reconstruction population. To reiterate, given the lack of symptomatic VTE diagnosed in our series, further statistical analysis of the risk factors mentioned here was not possible.…”

Section: Discussionmentioning

confidence: 99%

“…As such, these patients are at risk of developing venous thromboembolism (VTE). Numerous reports have documented the frequency of and risk factors for developing a VTE after hip and knee arthroplasty, knee arthroscopy, lower extremity trauma, and even hip arthroscopy [2,3,5,7,16,17,29,35,41,43,45,47]. However, data with regard to VTE after multiligamentous knee reconstruction are scarce [9].…”

Section: Introductionmentioning

confidence: 99%

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Born¹,

Engasser

King

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Reconstruction of the multiligament-injured knee often involves extended surgical and tourniquet use times and often is performed in patients who have sustained concomitant fractures as well as vascular injuries, all of which would appear to predispose the patient to the potentially serious complications of deep vein thrombosis and perhaps pulmonary embolism, yet little is known about the frequency of venous thromboembolic (VTE) events after multiligamentous knee reconstruction. Questions/purposes The purposes of this study were to (1) determine the frequency of symptomatic VTE after multiligamentous knee reconstruction at a single institution; and (2) to determine associated risk factors for VTE in these patients. Methods The records of 134 (63% of the 213 consented individuals in our longitudinal database) patients who underwent primary (129 [96%]) or revision (five [4%]) multiligamentous knee reconstruction at a single institution between 1992 and 2013 were retrospectively reviewed. With two patients undergoing procedures bilaterally, this resulted in a total of 136 multiligamentous knee reconstructions. VTE for which clinical symptoms were evident and confirmed by imaging within 3 months after the reconstructive procedure was noted. Pre-and perioperative data were collected with respect to demographics, associated injuries, medical history, smoking status, and surgical data. Standard rehabilitation and thromboprophylaxis protocols were used in all patients. Results Three cases of symptomatic VTE (three deep vein thromboses) occurred after the 136 reconstructions (2%; 95% confidence interval, 0.53%-7.3%). Two of the three patients were obese and the remaining patient smoked and abused alcohol. However, as a result of a low frequency of VTE, no risk factors could be identified in this series. Conclusions Symptomatic VTE occurred in 2% of multiligamentous knee reconstructions at our institution while receiving thromboprophylaxis. This is similar to rates documented after anterior cruciate ligament reconstruction without thromboprophylaxis. Further multicenter research is required to identify the true frequency of and risk factors for developing VTE in patients undergoing multiligamentous knee reconstruction after knee dislocation. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…Hetsroni et al . found that the risk of developing a PE increased to more than six fold for patients over 40 years compared to less than 20 years, and that procedures taking longer than 90 minutes increased the risk of PE by a factor of three compared to surgeries taking less than 30 minutes 6. Prevention of DVTs following this commonly performed surgery can not only lead to postoperative morbidity and mortality, but also reduced hospital stays and healthcare costs 13–18…”

Section: Discussionmentioning

confidence: 99%

“…As a result, controversy has surrounded the use of thromboprophylaxis in routine arthroscopy of the knee. Current literature, however, reports an incidence of deep vein thrombosis (DVT) of 9.9% overall and 2.1% for proximal DVTs,5 and a pulmonary embolism (PE) rate of 0.028%6 in patients undergoing routine knee arthroscopy.…”

Section: Introductionmentioning

confidence: 99%

Thromboprophylaxis in routine arthroscopy of knee

Abouali

Farrokhyar

Peterson

et al. 2013

IJOO

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Background:Thromboprophylaxis in arthroscopy is controversial. Recent literature has shown variable rates of deep vein thrombosis following routine arthroscopic knee surgery; however, it is unknown if current practice reflects the literature. We have conducted a cross sectional survey to provide insight into the practice patterns perceived risks, benefits and barrier in the use of thromboprophylaxis.Materials and Methods:A 19 item survey was created regarding surgeons' use of thromboprophylaxis in their patients undergoing routine knee arthroscopy. E-mail surveys were sent out to members of the Canadian Orthopaedic Association.Results:Seventy-seven responses were obtained; of which 58.2% (n=45) of surgeons stated that they had a clinical interest in sports medicine, and 37.3% (n=29) had completed a fellowship in sports medicine or arthroscopy. Fifty five surgeons (71.6%) performed more than 40 arthroscopies per year. Prolonged surgical time was the only risk factor that would significantly increase their use of prophylaxis. Practice patterns surrounding the use of thromboprophylaxis were otherwise quite variable.Conclusions:Our survey reveals that opinions and practice patterns surrounding the use of thromboprophylaxis following routine knee arthroscopy are diverse. This survey points out the need for larger well designed studies for concise guidelines.

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Symptomatic pulmonary embolism after outpatient arthroscopic procedures of the knee

Cited by 73 publications

References 25 publications

Season of Sampling and Season of Birth Influence Serotonin Metabolite Levels in Human Cerebrospinal Fluid

Season of Sampling and Season of Birth Influence Serotonin Metabolite Levels in Human Cerebrospinal Fluid

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Thromboprophylaxis in routine arthroscopy of knee

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