THROMBOEMBOLISM IN PATIENTS UNDERGOING THORACOTOMY

To determine the incidence of thromboembolism in relation to thoracoto my, 77 patients undergoing pulmonary resection were prospectively stud ied up to 30 days postoperatively for deep venous thrombosis and pulmo nary embolism. Overall, 20 of 77 patients (26%) had thromboembolic eve nts during their hospitalization. Four deep venous thromboses and 1 pu lmonary embolism were detected in 5 of 77 patients preoperatively for an incidence of 6%. Postoperative thromboembolism was detected in 15 o f 77 (19%): deep venous thrombosis in 11 (14%) and pulmonary embolism in 4 (5%). No postoperative thromboembolisms occurred in the 17 patien ts receiving preoperative aspirin or ibuprofen, whereas they did occur in 25% of the remainder (15/60). Thromboembolism after pulmonary rese ction was more frequent with bronchogenic carcinoma than with metastat ic cancer or benign disease (15/59 [25%] versus 0/18 [0%]; p < 0.01), adenocarcinoma compared with other types of carcinoma (11/25 [44%] ver sus 4/34 [12%]; p < 0.0004), large primary lung cancer (>3 cm in diame ter) compared with smaller lesions (9/19 [47%] versus 6/40 [15%]; p < 0.0001), stage II compared with stage I (7/14 [50%] versus 7/34 [21%]; p < 0.04), and pneumonectomy or lobectomy compared with segmentectomy and wedge resection (14/49 129%] versus 1/28 [4%]; p < 0.005). Three of 4 patients with thromboembolism detected preoperatively had operati on within the previous year. Postoperative pulmonary embolism was fata l in 1 of 4 (25%) and accounted for the one death. These results sugge st patients undergoing thoracotomy for lung cancer, especially adenoca rcinoma, should be considered for thromboembolic prophylaxis.