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

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.

The use of spiral computed tomography scans for the detection of pulmonary embolism.

Total joint arthroplasty carries a risk of symptomatic pulmonary embolism (PE). This study examined symptoms and risk factors of patients who underwent postoperative spiral computed tomography (CT) scans. The presenting symptoms and risk factors of total hip arthroplasty and total knee arthroplasty patients who had a postoperative CT scan were reviewed and the location of PE/deep vein thrombosis (DVT) was noted for positive scans. Of the 10209 patients who had total hip or total knee arthroplasty, 478 (4.7%) underwent a spiral CT scan to rule out PE and 136 (1.3%) had scans positive for PE. Twenty-two and four tenths percent of scans were positive for PE only, 2.1% for proximal DVT only, and 6.1% for PE and proximal DVT. Patients taking estrogen and patients presenting with low oxygen saturation postoperatively were significantly (P = .010, P < .001) more likely to have a positive scan. Spiral CT is the gold standard for detection of PE. Thirty-one and one half percent of scans were positive for PE and/or DVT, yet only 19.2% of patients had a predisposing risk factor for PE. Total knee arthroplasty carried a greater risk for PE than THA.