HSS Journal

, Volume 6, Issue 1, pp 95–98 | Cite as

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

  • Han Jo Kim
  • Sarah Walcott-Sapp
  • Kristi Leggett
  • Anne Bass
  • Ronald S. Adler
  • Helene Pavlov
  • Geoffrey H. Westrich
Original Article


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.


spiral CT orthopedic surgery thromboembolic complications 


  1. 1.
    Freedman KB, Brookenthal KR, Fitzgerald RH et al, A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J. Bone Jt. Surg. Am. 2000; 82-A: 929–938Google Scholar
  2. 2.
    Westrich GH, Haas SB, Mosca P, et al, Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty. J. Bone Jt. Surg. Br. 2000; 82: 795–800CrossRefGoogle Scholar
  3. 3.
    Kim YH, Oh SH, Kim JS, Incidence and natural history of deep-vein thrombosis after total hip arthroplasty. A prospective and randomized clinical study. J. Bone Jt. Surg. Br. 2003; 85: 661–665CrossRefGoogle Scholar
  4. 4.
    Lawton RL, Morrey BF, Narr BJ, Validity of index of suspicion for pulmonary embolism after hip arthroplasty. Clin. Orthop. Relat. Res. 2003; 415: 180–192CrossRefPubMedGoogle Scholar
  5. 5.
    Geerts WH, Code KI, Jay RM, A prospective study of venous thromboembolism after major trauma. N. Engl. J. Med. 1994; 331: 1601–1606CrossRefPubMedGoogle Scholar
  6. 6.
    Brambilla S, Ruosi C, LaMaida GA, et al, Prevention of venous thromboembolism in spinal surgery. Eur. Spine J. 2004; 13: 1–8CrossRefPubMedGoogle Scholar
  7. 7.
    Catre MG Anticoagulation in spinal surgery. A critical review of the literature. Can. J. Surg. 1997; 40: 413–419PubMedGoogle Scholar
  8. 8.
    Dearborn JT, Hu SS, Tribus CB, et al, Thromboembolic complications after major thoracolumbar spine surgery. Spine. 1999; 24: 1471–1476CrossRefPubMedGoogle Scholar
  9. 9.
    Oda T, Fuji T, Kato Y, et al, Deep venous thrombosis after posterior spinal surgery. Spine 2000; 25: 2962–2967CrossRefPubMedGoogle Scholar
  10. 10.
    Lyman S, Sherman S, Carter TI, et al, Prevalence and risk factors for symptomatic thromboembolic events after shoulder arthroplasty. Clin. Orthop. Relat. Res. 2006; 448: 152–156CrossRefPubMedGoogle Scholar
  11. 11.
    Hanslow SS, Grujic L, Slater HK, et al, Thromboembolic disease after foot and ankle surgery. Foot Ankle Int. 2006; 27: 693–695PubMedGoogle Scholar
  12. 12.
    Mizel MS, Temple HT, Michelson JD, et al Thromboembolism after foot and ankle surgery. Clin. Orthop. Relat. Res. 1998; 348: 180–185CrossRefPubMedGoogle Scholar
  13. 13.
    Ghaye B, Ghuysen A, Bruyere PJ, et al, Can CT pulmonary angiography allow assessment of severity and prognosis in patients presenting with pulmonary embolism? What the radiologist needs to know. Radiographics. 2006; 26: 23–39CrossRefPubMedGoogle Scholar
  14. 14.
    Kokturk N, Oguzulgen IK, Demir N, et al, Differences in clinical presentation of pulmonary embolism in older vs. younger patients. Circ. J. 2005; 69:981–986CrossRefPubMedGoogle Scholar
  15. 15.
    Miniati M, Prediletto R, Formichi B, et al, Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am. J. Respir. Crit. Care Med. 1999;159:864–871PubMedGoogle Scholar
  16. 16.
    Stein PD, Henry JW Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997; 112:974–979CrossRefPubMedGoogle Scholar
  17. 17.
    Wells PS, Ginsberg JS, Anderson DR, et al, Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann. Intern. Med. 2005; 129: 997–1005Google Scholar
  18. 18.
    Parvizi J, Smith EB, Pulido L, et al, The rise in the incidence of pulmonary embolus after joint arthroplasty: is modern imaging to blame? Clin. Orthop. Relat. Res. 2007; 463: 107–113PubMedGoogle Scholar
  19. 19.
    Douketis JD, The clinical utility of a rapid beside d-dimer assay for screening of deep vein thrombosis following orthopaedic surgery. Thrombosis Haemost. 1997; 78: 1300Google Scholar
  20. 20.
    Douketis JD, The clinical utility of a rapid beside d-dimer assay for screening of deep vein thrombosis following orthopaedic surgery. Thrombosis Haemost. 1997; 78: 1300Google Scholar

Copyright information

© Hospital for Special Surgery 2009

Authors and Affiliations

  • Han Jo Kim
    • 2
  • Sarah Walcott-Sapp
    • 2
  • Kristi Leggett
    • 3
  • Anne Bass
    • 1
  • Ronald S. Adler
    • 3
  • Helene Pavlov
    • 3
  • Geoffrey H. Westrich
    • 2
  1. 1.Department of RheumatologyHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Orthopedic SurgeryHospital for Special SurgeryNew YorkUSA
  3. 3.Department of RadiologyHospital for Special SurgeryNew YorkUSA

Personalised recommendations