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

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.

This is a preview of subscription content, log in to check access.

References

  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: 929–938

    CAS  Google 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: 795–800

    Article  CAS  Google 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: 661–665

    Article  Google 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: 180–192

    Article  PubMed  Google Scholar 

  5. 5.

    Geerts WH, Code KI, Jay RM, A prospective study of venous thromboembolism after major trauma. N. Engl. J. Med. 1994; 331: 1601–1606

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Brambilla S, Ruosi C, LaMaida GA, et al, Prevention of venous thromboembolism in spinal surgery. Eur. Spine J. 2004; 13: 1–8

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Catre MG Anticoagulation in spinal surgery. A critical review of the literature. Can. J. Surg. 1997; 40: 413–419

    CAS  PubMed  Google Scholar 

  8. 8.

    Dearborn JT, Hu SS, Tribus CB, et al, Thromboembolic complications after major thoracolumbar spine surgery. Spine. 1999; 24: 1471–1476

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Oda T, Fuji T, Kato Y, et al, Deep venous thrombosis after posterior spinal surgery. Spine 2000; 25: 2962–2967

    Article  CAS  PubMed  Google 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: 152–156

    Article  PubMed  Google Scholar 

  11. 11.

    Hanslow SS, Grujic L, Slater HK, et al, Thromboembolic disease after foot and ankle surgery. Foot Ankle Int. 2006; 27: 693–695

    PubMed  Google Scholar 

  12. 12.

    Mizel MS, Temple HT, Michelson JD, et al Thromboembolism after foot and ankle surgery. Clin. Orthop. Relat. Res. 1998; 348: 180–185

    Article  PubMed  Google 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: 23–39

    Article  PubMed  Google 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; 69:981–986

    Article  PubMed  Google 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;159:864–871

    CAS  PubMed  Google Scholar 

  16. 16.

    Stein PD, Henry JW Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997; 112:974–979

    Article  CAS  PubMed  Google 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: 997–1005

    Google 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: 107–113

    PubMed  Google 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: 1300

    CAS  Google 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: 1300

    CAS  Google Scholar 

Download references

Acknowledgment

The authors would like to acknowledge Lindsey Bornstein for her assistance in the preparation of this manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Geoffrey H. Westrich MD.

Additional information

Each author certifies that his or her institution has approved the reporting of these cases and that all investigations were conducted in conformity with ethical principles of research.

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kim, H.J., Walcott-Sapp, S., Leggett, K. et al. Detection of Pulmonary Embolism in the Postoperative Orthopedic Patient Using Spiral CT Scans. HSS Jrnl 6, 95–98 (2010). https://doi.org/10.1007/s11420-009-9128-5

Download citation

Keywords

  • spiral CT
  • orthopedic surgery
  • thromboembolic complications