HSS Journal

, Volume 6, Issue 1, pp 95–98

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

Authors

  • Han Jo Kim
    • Department of Orthopedic SurgeryHospital for Special Surgery
  • Sarah Walcott-Sapp
    • Department of Orthopedic SurgeryHospital for Special Surgery
  • Kristi Leggett
    • Department of RadiologyHospital for Special Surgery
  • Anne Bass
    • Department of RheumatologyHospital for Special Surgery
  • Ronald S. Adler
    • Department of RadiologyHospital for Special Surgery
  • Helene Pavlov
    • Department of RadiologyHospital for Special Surgery
    • Department of Orthopedic SurgeryHospital for Special Surgery
Original Article

DOI: 10.1007/s11420-009-9128-5

Cite this article as:
Kim, H.J., Walcott-Sapp, S., Leggett, K. et al. HSS Jrnl (2010) 6: 95. doi:10.1007/s11420-009-9128-5

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.

Keywords

spiral CT orthopedic surgery thromboembolic complications

Copyright information

© Hospital for Special Surgery 2009