Postoperative fatal pulmonary embolism in a general surgical department

This retrospective study describes the cases of postoperative pulmonary embolism (PE) in a general surgical department during a 3-year period.

To analyze the cases of PE, all patient data from the hospital central registry of diagnoses, pulmonary ventilation/perfusion scintigraphies (V/P scans), and autopsy records from a hospital in Denmark for the 3-year period from August 1986 to August 1989 were reviewed. Antithrombotic prophylaxis was applied routinely according to standard instructions. A total of 2,049 emergency and 2,832 elective operations were performed. The PEs were verified by autopsy or perfusion/ventilation scintigraphy.

Postoperative PE was verified in 30 patients, which is equivalent to an incidence of 0.6% (95% confidence 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 of fatal PE was 0.4% (0.2% to 0.5%). Fatal PE was found in 8.6% (5.0% to 13.5%) of the patients who had an autopsy performed. The incidence of fatal postoperative PE among patients who received thromboprophylaxis was 3.5%, compared with 11.2% in patients who did not receive prophylaxis, P < 0.05. Pulmonary embolism occurred in 3 patients younger than 40 years, and in 12 patients who had undergone minor surgery.

The results of this retrospective study suggest that the incidence of fatal PE is reduced by low-dose heparin prophylaxis, and that the 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 indications for antithrombotic prophylaxis should also include minor surgery and patients aged less than 40 years. A standard instruction is strongly recommended for thromboprophylaxis in surgery, especially when dealing with emergency surgery.