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

Han Jo Kim, MD
Department of Orthopedic Surgery, Hospital for Special Surgery

Sarah Walcott-Sapp, BA
Department of Orthopedic Surgery, Hospital for Special Surgery

Kristi Leggett, AA
Department of Radiology, Hospital for Special Surgery


Anne R. Bass, MD

Anne R. Bass, MD

Associate Attending Physician, Hospital for Special Surgery
Program Director Rheumatology Fellowship Program, Hospital for Special Surgery
Associate Professor of Clinical Medicine, Weill Cornell Medical College

Helene Pavlov, MD, FACR

Helene Pavlov, MD, FACR

Radiologist-in-Chief Emeritus, Hospital for Special Surgery

Geoffrey H. Westrich, MD

Geoffrey H. Westrich, MD

Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Research Director of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery
Assistant Scientist, Hospital for Special Surgery
Co-Chairman, Complex Case Review Panel, Hospital for Special Surgery
Associate Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College

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 article appears in HSS Journal: Volume 6, Number 1.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

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