Summary
A study of post-mortem examinations performed between 1970 and 1979 at a specialist orthopaedic hospital revealed that the overall mortality rate due to pulmonary embolism was 0.23% and that pulmonary embolism was responsible for 19.1% of hospital deaths. The majority of these fatalities occurred following operation for either fractured proximal femur or total hip replacement. During the decade, 928 patients were operated upon for fractured proximal femur, none received prophylactic anticoagulation therapy and the mortality rate due to pulmonary embolism was 17.7%. However, the yearly mortality rate decreased with time and this change was attributed to earlier operation and early mobilisation. Over the same period, 3016 patients underwent total hip replacement, 20% were anticoagulated prophylactically; the mortality rate due to pulmonary embolism was 0.63%. In those patients who died of pulmonary embolism, post-mortem evidence of deep vein thrombosis was usually found, but no relationship between site of thrombosis and side of operation was observed. Pulmonary embolism was diagnosed in only a few patients although on later consideration at least a third of patients had symptoms suggestive of previous emboli. Possible improvements in diagnosis are discussed and a more rational approach to prophylactic anticoagulation suggested.
Zusammenfassung
Von 1970 his 1979 wurden Obduktionen in einem orthopädischen Krankenhaus vorgenommen. Man hat dabei festgestellt, daß die Gesamtsterblichkeitsziffer infolge Lungenembolie 0,23% betrug und daß 19,1% der Todesfälle im Krankenhaus auf Lungenembolie zurückzuführen waren. Die Mehrzahl dieser Todesfälle ereignete sich entweder nach Proximal-Oberschenkelfrakturoperationen oder nach Hüft-gelenkersatzoperationen. Während eines Jahrzehntes wurden 928 Patienten an der Proximal-Oberschenkelfraktur operiert, keine bekamen die AnticoagulansProphylaxe und die Sterblichkeitsziffer, infolge Lungenembolie, betrug 17,7%. Jedoch verminderte sich die jährliche Sterblichkeitsziffer, und man führte diese Veränderung auf frühzeitige Operation und Mobilisation zurück. Zur selben Zeit unterzogen sich 3016 Patienten einer Hüftgelenkersatzoperation, davon waren 20% Anticoagulans-Prophylaxe; die Sterblichkeitsziffer, infolge Lungenembolie, betrug 0,63%. Man fand gewöhnlich Leichenspuren der Tiefvenenthrombose bei jenen Patienten, die an Lungenembolie starben, aber es war keine Verbindung zwischen der Thrombosenlage und der Operationsseite zu bemerken. Lungenembolic war nur bei wenigen Patienten feststellbar, obwohl bei weiterer Untersuchung mindestens ein Drittel der Patienten andeutungsweise Symptome einer früheren Embolie besaßen. Mögliche Verbesserungen der Diagnose werden diskutiert, und eine rationellere Behandlung der Anticoagulans-Prophylaxe wird vorgeschlagen.
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Sheppeard, H., Henson, J., Ward, D.J. et al. A clinico-pathological study of fatal pulmonary embolism in a specialist orthopaedic hospital. Arch. Orth. Traum. Surg. 99, 65–71 (1981). https://doi.org/10.1007/BF00400912
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DOI: https://doi.org/10.1007/BF00400912