Abstract
Purpose
This study aimed to examine the incidence, case fatality rate, and characteristics of perioperative symptomatic pulmonary thromboembolism (PS-PTE) throughout Japan.
Methods
From 2002 to 2011, confidential questionnaires were mailed annually to all Japanese Society of Anesthesiologists-certified training hospitals for data collection to determine the incidence and case fatality rate of PS-PTE patients. Data from 10,537 institutions in which a total of 11,786,489 surgeries had been performed were analyzed using the Mann–Whitney and Chi-square tests.
Results
In total, 3,667 PS-PTE cases were identified. The average incidence of PS-PTE was 3.1 (2.2–4.8) per 10,000 surgeries, and the average case fatality rate was 17.9 % (12.9–28.8 %). The incidence of PS-PTE began to significantly decrease in 2004 compared with that of 2002 (0.0036 vs. 0.0044 %: p < 0.01). The case fatality rate temporarily increased toward 2005 (17.9 to 28.8 %); however, it gradually decreased since 2008 (15.7 %) and was the lowest (12.9 %) in 2011. Regarding the trends in prophylaxis, the rate of mechanical prophylaxis increased significantly in 2003 compared with that of 2002 (59.5 vs. 35.0 %: p < 0.01), and almost plateaued (73.1–83.1 %) after 2004. Furthermore, the rate of pharmacological prophylaxis started increasing in 2008 (17.6 %) and reached around 30 % after 2009 (28.8–30.2 %).
Conclusions
The results of our 10-year survey study show that the incidence of PS-PTE decreased significantly since 2004, and the case fatality rate seemed to show a downward trend since 2008. Major changes in the distribution of prophylaxis in PS-PTE patients were observed.
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Appendices
Appendix A: The percentage of surgeries in each condition
2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | Average | |
|---|---|---|---|---|---|---|---|---|---|---|---|
Age (years) | |||||||||||
0-5 | 6.2 | 6.1 | 6.0 | 6.0 | 6.0 | 6.0 | 5.2 | 4.8 | 4.8 | 4.5 | 5.5 |
6-18 | 7.0 | 6.8 | 6.6 | 6.6 | 6.6 | 6.6 | 6.1 | 6.0 | 5.9 | 6.0 | 6.4 |
19-65 | 54.7 | 53.8 | 53.4 | 53.4 | 53.4 | 53.4 | 50.7 | 50.0 | 49.5 | 49.5 | 52.2 |
66-85 | 29.8 | 30.9 | 31.5 | 31.5 | 31.5 | 31.5 | 34.9 | 35.9 | 36.2 | 36.4 | 33.0 |
86- | 2.3 | 2.4 | 2.6 | 2.6 | 2.6 | 2.6 | 3.1 | 3.3 | 3.6 | 3.7 | 2.9 |
Sex | |||||||||||
Male | No data | no data | 49.6 | 49.6 | 49.6 | 49.6 | 48.5 | 48.8 | 48.5 | 48.5 | 49.1 |
Female | No data | no data | 50.4 | 50.4 | 50.4 | 50.4 | 51.5 | 51.2 | 51.5 | 51.5 | 50.9 |
Surgical site | |||||||||||
Brain | 3.8 | 3.7 | 3.6 | 3.6 | 3.6 | 3.6 | 3.3 | 3.2 | 3.3 | 3.6 | 3.5 |
Thorax | 3.5 | 3.6 | 3.5 | 3.5 | 3.5 | 3.5 | 3.3 | 3.4 | 3.5 | 3.4 | 3.5 |
Heart and/or major vascular | 3.4 | 3.4 | 3.3 | 3.3 | 3.3 | 3.3 | 3.1 | 3.0 | 3.2 | 3.4 | 3.3 |
Thorax and abdomen | 0.6 | 0.6 | 0.6 | 0.6 | 0.6 | 0.6 | 0.5 | 0.4 | 0.5 | 0.5 | 0.6 |
Abdomen | 29.4 | 29.1 | 30.1 | 30.1 | 30.1 | 30.1 | 29.2 | 29.1 | 28.7 | 33.0 | 29.9 |
Cesarean section | 3.5 | 3.5 | 3.5 | 3.5 | 3.5 | 3.5 | 3.7 | 3.7 | 3.6 | 3.6 | 3.6 |
Head, pharynx,larynx | 15.2 | 15.0 | 14.9 | 14.9 | 14.9 | 14.9 | 14.2 | 14.0 | 13.9 | 13.0 | 14.5 |
Chest/abdominal wall/perineum | 15.6 | 16.3 | 15.7 | 15.7 | 15.7 | 15.7 | 15.5 | 15.8 | 15.6 | 12.0 | 15.4 |
Spine | 3.6 | 3.7 | 3.7 | 3.7 | 3.7 | 3.7 | 4.6 | 4.8 | 5.0 | 4.9 | 4.1 |
Hip, upper/lower limbs | 18.0 | 18.0 | 18.5 | 18.5 | 18.5 | 18.5 | 19.6 | 20.2 | 20.1 | 20.3 | 19.0 |
Appendix B: The estimated number of surgeries in each condition
2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | Total | Average | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Total number of surgeries | 837,540 | 925,260 | 1,131,154 | 922,453 | 1,209,135 | 1,150,783 | 1,177,626 | 1,422,034 | 1,560,987 | 1,449,517 | 11,786,489 | 1,178,649 |
Age (years) | ||||||||||||
0-5 | 51,901 | 56,176 | 67,499 | 55,046 | 72,153 | 68,671 | 61,452 | 68,288 | 75,167 | 65,347 | 641,700 | 64,170 |
6-18 | 58,295 | 63,070 | 74,935 | 61,109 | 80,101 | 76,236 | 71,816 | 85,517 | 91,812 | 86,873 | 749,763 | 74,976 |
19-65 | 458,487 | 497,691 | 603,742 | 492,350 | 645,363 | 614,219 | 596,468 | 710,718 | 772,573 | 716,952 | 6,108,562 | 610,856 |
66-85 | 249,985 | 285,994 | 355,925 | 290,256 | 380,462 | 362,101 | 411,266 | 510,675 | 565,447 | 526,928 | 3,939,037 | 393,904 |
86- | 18,873 | 22,329 | 29,053 | 23,693 | 31,056 | 29,557 | 36,625 | 46,836 | 55,988 | 53,417 | 347,427 | 34,743 |
Male | N/A | N/A | 560,509 | 457,094 | 599,150 | 570,236 | 571,676 | 694,260 | 756,960 | 702,783 | 4,912,668 | 614,084 |
Female | N/A | N/A | 570,645 | 465,359 | 609,985 | 580,547 | 605,950 | 727,774 | 804,027 | 746,734 | 5,111,021 | 638,878 |
Surgical site | ||||||||||||
Brain | 31,831 | 34,439 | 40,519 | 33,043 | 43,312 | 41,222 | 38,776 | 46,185 | 51,308 | 51,748 | 412,383 | 41,238 |
Thorax | 29,417 | 33,613 | 39,788 | 32,447 | 42,531 | 40,479 | 39,303 | 48,112 | 55,360 | 49,308 | 410,359 | 41,036 |
Heart and/or major vascular | 28,483 | 31,060 | 37,443 | 30,535 | 40,024 | 38,093 | 37,091 | 42,318 | 50,176 | 49,702 | 384,924 | 38,492 |
Thorax and abdomen | 5,373 | 5,594 | 6,732 | 5,490 | 7,196 | 6,849 | 5,786 | 6,176 | 7,659 | 6,811 | 63,665 | 6,367 |
Abdomen | 246,621 | 269,105 | 340,032 | 277,295 | 363,474 | 345,933 | 344,175 | 413,200 | 448,640 | 478,104 | 3,526,578 | 352,658 |
Cesarean section | 29,426 | 32,784 | 39,862 | 32,507 | 42,610 | 40,553 | 44,140 | 52,489 | 55,447 | 51,967 | 421,785 | 42,178 |
Head, pharynx,larynx | 127,209 | 138,648 | 168,741 | 137,608 | 180,374 | 171,669 | 167,179 | 198,841 | 217,726 | 188,351 | 1,696,347 | 169,635 |
Chest/abdominal wall/perineum | 130,924 | 150,695 | 177,753 | 144,957 | 190,008 | 180,838 | 182,888 | 224,855 | 244,127 | 174,100 | 1,801,146 | 180,115 |
Spine | 30,312 | 34,199 | 41,755 | 34,051 | 44,633 | 42,479 | 54,676 | 68,396 | 77,778 | 71,009 | 499,289 | 49,929 |
Hip, upper/lower limbs | 150,541 | 166,723 | 209,660 | 170,977 | 224,114 | 213,299 | 231,085 | 286,974 | 314,499 | 294,028 | 2,261,899 | 226,190 |
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Kuroiwa, M., Morimatsu, H., Tsuzaki, K. et al. Changes in the incidence, case fatality rate, and characteristics of symptomatic perioperative pulmonary thromboembolism in Japan: Results of the 2002–2011 Japanese Society of Anesthesiologists Perioperative Pulmonary Thromboembolism (JSA-PTE) Study. J Anesth 29, 433–441 (2015). https://doi.org/10.1007/s00540-014-1939-y
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DOI: https://doi.org/10.1007/s00540-014-1939-y