POSTOPERATIVE FATAL PULMONARY-EMBOLISM IN A GENERAL SURGICAL DEPARTMENT

BACKGROUND: This retrospective study describes the cases of postoperat ive pulmonary embolism (PE) in a general surgical department during a 3-year period. METHODS: To analyze the eases of PE, all patient data f rom the hospital central registry of diagnoses, pulmonary ventilation/ perfusion scintigraphies (V/P scans), and autopsy records from a hospi tal in Denmark for the 3-year period from August 1986 to August 1989 w ere reviewed. Antithrombotic prophylaxis was applied routinely accordi ng to standard instructions. A total of 2,049 emergency and 2,832 elec tive operations were performed. The PEs were verified by autopsy or pe rfusion/ventilation scintigraphy. RESULTS: Postoperative PE was verifi ed in 30 patients, which is equivalent to an incidence of 0.6% (95% co nfidence limits: 0.4% to 0.8%). With correction for autopsy rate (65%) the incidence is estimated to be 1.0% (0.6% to 1.3%). The incidence o f fatal PE was 0.4% (0.2% to 0.5%). Fatal PE was found in 8.6% (5.0% t o 15.5%) of the patients,who had an autopsy performed. The incidence o f fatal postoperative PE among patients who received thromboprophylaxi s was 3.5%, compared with 11.2% in patients who did not receive prophy laxis, P <0.05. Pulmonary embolism occurred in 3 patients younger than 40 years, and in 12 patients who had undergone minor surgery. CONCLUS IONS: The results of this retrospective study suggest that the inciden ce of fatal PE is reduced by low-dose heparin prophylaxis, and that th e risk of developing PE is not limited to patients subjected to major surgery or older than 40 years of age. It is concluded that the indica tions for antithrombotic prophylaxis should also include minor surgery and patients aged less than 40 years. A standard instruction is stron gly recommended for thromboprophylaxis in surgery, especially when dea ling with emergency surgery.