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Clinical Orthopaedics and Related Research®

, Volume 470, Issue 2, pp 497–502 | Cite as

Overdiagnosis of Pulmonary Embolism: Evaluation of a Hypoxia Algorithm Designed to Avoid This Catastrophic Problem

  • Brian S. Winters
  • Mark Solarz
  • Christina L. JacovidesEmail author
  • James J. Purtill
  • Richard H. Rothman
  • Javad Parvizi
Symposium: Papers Presented at the Annual Meetings of The Hip Society

Abstract

Background

We observed a substantial increase in the incidence of pulmonary embolism (PE) after total joint arthroplasty (TJA) when multidetector computerized tomography (MDCT) replaced ventilation-perfusion (V/Q) scans as the diagnostic modality of choice. We questioned whether this resulted from the detection of clinically unimportant PE with the more sensitive MDCT and in 2007 instituted a hypoxia protocol to enhance the detection of PE.

Questions/purposes

We determined whether this new hypoxia protocol increased the specificity of our workups for suspected clinically important PE in the immediate postoperative period without affecting patient morbidity and mortality.

Patients and Methods

We compared the frequency of MDCT, V/Q scan and total investigations, incidence of PE, and overall mortality rates in the 3 years prior (January 2003 to December 2006) and 2 years after (January 2007 to November 2009) the implementation of the algorithm.

Results

After instituting the protocol, we observed a trend toward a decrease in the number of patients worked up for PE (4.6 to 4.0 per 100 TJAs, 13.5% decrease). At the same time, there was an increase in the percent of positive findings of PE per workup for PE (23–33 positive PEs per 100 patients, 40.5% increase). All-cause mortality rates decreased for the 30-day period (3.1 to 1.4 per 1000 TJAs, 53.5% decrease) and the 90-day period (5.0 to 2.6 per 1000 TJAs, 48.3% decrease).

Conclusions

With the implementation of this algorithm, the specificity of our management of postoperative hypoxia and suspected clinically important PE improved without affecting patient morbidity or mortality.

Keywords

Pulmonary Embolism Total Joint Arthroplasty Protocol Change Pulmonary Embolism Diagnosis Transient Hypoxia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Brian S. Winters
    • 1
  • Mark Solarz
    • 1
  • Christina L. Jacovides
    • 1
    Email author
  • James J. Purtill
    • 1
  • Richard H. Rothman
    • 1
  • Javad Parvizi
    • 1
  1. 1.The Rothman Institute of Orthopedics at Thomas Jefferson University HospitalPhiladelphiaUSA

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