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Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study

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Pulmonary embolism (PE) is a cause of death after total hip and knee arthroplasty (THA, TKA). We characterised the patient population suffering from in-hospital PE and identified perioperative risk factors associated with PE using nationally representative data. Data from the National Hospital Discharge Survey between 1990 and 2004 on patients who underwent primary or revision THA/TKA in the United States were analysed. Multivariate regression analysis was performed to determine if perioperative factors were associated with increased risk of in-hospital PE. An estimated 6,901,324 procedures were identified. The incidence of in-hospital PE was 0.36%. Factors associated with an increased risk for the diagnosis of PE included: revision THA, female gender, dementia, obesity, renal and cerebrovascular disease. An increased association with PE was found among patients with diagnosis of Adult Respiratory Distress Syndrome (ARDS), psychosis (confusion), and peripheral thrombotic events. Our findings may be useful in stratifying the individual patient’s risk of PE after surgery.


L’embolie pulmonaire (PE) est une cause de décès après prothèse totale de hanche ou du genou (THA, TKA). Nous avons essayé de déterminer quelle population pouvait présenter une telle complication et identifier les facteurs de risques pré-opératoires. Pour cela, nous avons analysé nos données hospitalières nationales entre 1990 et 2004 sur tous les patients ayant bénéficié d’une prothèse de hanche ou du genou primaire ou de révision aux Etats-Unis. Une analyse statistique a été réalisée afin de déterminer quels sont les facteurs de risque péri-opératoires associés. 6 901 324 procédures ont été identifiées. Le pourcentage d’embolie pulmonaire durant l’hospitalisation a été de 0,36%. Les facteurs associés sont la révision prothétique, le sexe féminin, la démence, l’obésité, les problèmes rénaux et les problèmes cérébraux vasculaires. Le taux le plus élevé d’embolie pulmonaire a été également trouvé chez les patients ayant un diagnostic d’ARDS et de troubles confusionnels ainsi que d’évènements thrombotiques périphériques. Ces données peuvent être utiles pour évaluer le risque d’embolie pulmonaire chez les patients après chirurgie arthroplastique.

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Correspondence to Stavros G. Memtsoudis.

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Financial disclosure

This study was funded by the Hospital for Special Surgery Anesthesiology Young Investigator Award provided by the Department of Anesthesiology at the Hospital for Special Surgery.



The following table is a list of ICD-9 diagnosis codes included to identify comorbidities, adverse diagnoses, and complications among discharges. (Four- and five-digit codes are included under the respective three- and four-digit codes.)

Table 3

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Memtsoudis, S.G., Besculides, M.C., Gaber, L. et al. Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study. International Orthopaedics (SICOT) 33, 1739–1745 (2009).

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