In the JournalsPerspectiveFrom OT Europe

Elevated PE risk seen beyond 6 weeks after various types of surgery

Regardless of the surgery type, the risk of postoperative pulmonary embolism was elevated at more than 6 weeks postoperatively, according to published results.

Using a French national inpatient database, researchers performed a case-crossover analysis of 60,703 cancer-free middle-aged patients with a diagnosis of a first pulmonary embolism (PE) who underwent either hip or knee replacement (n=989), fracture surgery (n=1,146), other orthopedic procedures (n=1,944), vascular surgery (n=1,002), gynecological surgery (n=522) or gastrointestinal surgery (n=2,061). Diagnosis of a first PE was the primary outcome.

Results showed that after all types of surgery, the risk of postoperative PE was elevated for a minimum of 12 weeks. The risk of PE for all surgery types was highest during the immediate postoperative period from 1 week to 6 weeks.

“The excess risk of postoperative pulmonary embolism ranged from odds ratio (OR), 5.24 (95% CI, 3.91-7.01) for vascular surgery to OR, 8.34 (95% CI, 6.07-11.45) for surgery for fractures,” the researchers wrote. From 7 to 12 weeks, the risk remained elevated with an OR of 2.26 for gastrointestinal operations to an OR of 4.23 for surgery for fractures. For all types of surgery, there was no clinically significant risk after 18 weeks postoperatively.

After orthopedic surgeries not linked with fracture surgery, there was a lower risk of late postoperative PE between 7 to 12 weeks postoperatively. Investigators noted the odds ratios after hip or knee replacement and after other orthopedic procedures during this time were 3.64 and 2.82, respectively. – by Monica Jaramillo

Disclosure s : The authors report no relevant financial disclosures.

Regardless of the surgery type, the risk of postoperative pulmonary embolism was elevated at more than 6 weeks postoperatively, according to published results.

Using a French national inpatient database, researchers performed a case-crossover analysis of 60,703 cancer-free middle-aged patients with a diagnosis of a first pulmonary embolism (PE) who underwent either hip or knee replacement (n=989), fracture surgery (n=1,146), other orthopedic procedures (n=1,944), vascular surgery (n=1,002), gynecological surgery (n=522) or gastrointestinal surgery (n=2,061). Diagnosis of a first PE was the primary outcome.

Results showed that after all types of surgery, the risk of postoperative PE was elevated for a minimum of 12 weeks. The risk of PE for all surgery types was highest during the immediate postoperative period from 1 week to 6 weeks.

“The excess risk of postoperative pulmonary embolism ranged from odds ratio (OR), 5.24 (95% CI, 3.91-7.01) for vascular surgery to OR, 8.34 (95% CI, 6.07-11.45) for surgery for fractures,” the researchers wrote. From 7 to 12 weeks, the risk remained elevated with an OR of 2.26 for gastrointestinal operations to an OR of 4.23 for surgery for fractures. For all types of surgery, there was no clinically significant risk after 18 weeks postoperatively.

After orthopedic surgeries not linked with fracture surgery, there was a lower risk of late postoperative PE between 7 to 12 weeks postoperatively. Investigators noted the odds ratios after hip or knee replacement and after other orthopedic procedures during this time were 3.64 and 2.82, respectively. – by Monica Jaramillo

Disclosure s : The authors report no relevant financial disclosures.

    Perspective

    Caron and colleagues evaluate the respective risks of pulmonary embolism after six types of surgery using data on cancer-free, middle-aged (45 to 64 years) adults from a French national inpatient database. The authors include more than 60,000 patients, 4,079 of whom underwent orthopedic surgery. Currently, the American Academy of Orthopaedic Surgeons and American College of Chest Physicians (ACCP) recommend venous thromboembolism chemoprophylaxis following lower extremity arthroplasty for up to 35 days. However, the findings of this study suggest that patients undergoing orthopedic intervention are at an increased risk of pulmonary embolism as much as 32 weeks from the time of surgery, with the highest risk incurred postoperative weeks 1 to 6 (OR 5.44 following joint arthroplasty, OR 8.34 for fracture) and postoperative weeks 6 to 12 (OR 3.64 following joint arthroplasty, OR 4.23 for fracture).

    Recommendations from the AAOS and ACCP likely weighed the benefits and risks of anticoagulation in the setting of higher intensity chemoprophylactic agents, such as enoxaparin and warfarin. However, in the era of aspirin chemoprophylaxis, this article raises the important question of whether prolonged prophylaxis with lower intensity anticoagulants is warranted. The authors should be commended for this interesting work, but it is important to note that this is just one retrospective database study with a relatively small, heterogenous sample and that further formal evaluation is still necessary.

    • Nikunj N. Trivedi, MD
    • University Hospitals
      Cleveland

    Disclosures: Trivedi reports no relevant financial disclosures.