The frequency and detection of serious postoperative thromboembolic disease

A safe, sensitive and convenient technique using 131-I fibrinogen for detecting deep venous thrombosis in postoperative patients has been developed. A total of 47 volunteers over age 40 years about to undergo major operation were studied prospectively. Neither in 20 patients given heparin as part of the surgical procedure or for prevention of superficial phlebitis in the arm during intravenous therapy nor in the 27 others not given anticoagulants before, during or after operations was there evidence of venous thrombosis in the leg or pulmonary embolism either by the 131-I fibrinogen scan nor by clinical course. A retrospective review of hospital records confirmed the relative rarity of pulmonary embolism as a cause of identified morbidity and mortality in surgical patients. Of 54, 183 adult patients discharged from the University Hospitals of Cleveland during 1972 and 1973, 197, or 0.4 per cent, were diagnosed as having pulmonary embolism, and of these only 32, or 16 per cent, occurred in postoperative surgical patients. A review of the autopsy records of the same institution for the same time also revealed a low incidence of deaths due to pulmonary embolism among the surgical population, only 180, or 0.8 per cent, of the 22, 449 adult surgical admissions. Although feasible to perform, the value of the radiofibrinogen method of detecting deep venous thrombosis in postoperative patients as a routine measure is questioned.