Fatal pulmonary embolism associated with surgery. An autopsy study.

The records of all autopsies performed at two major Danish hospitals in 1986 were reviewed in order to analyze cases of fatal pulmonary embolism. There were 2,609 hospital deaths and 1,603 post mortem examinations. Pulmonary embolism was the primary cause of 74 deaths, 16 of which were postoperative. The median age of these ten men and six women was 72 years. In nine of the 16 cases the prognosis would have been favorable had embolism not occurred. Only three of the 16 had received thromboembolic prophylaxis. Four of the deaths from embolism occurred less than 24 hours after surgery, five within 7 days and seven between postoperative days 7 and 30. The estimated incidence of fatal pulmonary embolism following surgery was 1.2-1.3 per thousand.

[Presence of pulmonary emboli in Danish autopsy material]. / Forekomsten af lungeemboli i et dansk obduktionsmateriale.

Two hundred and ten patients with verified pulmonary emboli (LE) at autopsy were assessed retrospectively. These patients comprised 13% of all those submitted to autopsy. LE was the primary cause of death, a contributory cause of death or an incidental finding in 35%, 31% and 34%, respectively, of the cases. Two thirds of the lethal cases were not recognized prior to autopsy. LE was preceded by medical conditions and operation with subsequent immobilization in 55% and 22% of the cases, respectively. Out of these, it is estimated that 17% of the medical patients and 56% of the surgical patients would have had a good prognosis if LE had not occurred. If foreign results can be applied to Danish conditions, approximately 1,400 fatal cases of LE should occur in Denmark per annum. This review confirms that the actual Danish figures are of this magnitude, at least, as approximately 1,500 lethal cases must be assumed to occur per annum solely among patients dying in hospital. In 1986, a total of 278 cases of LE were stated as the primary cause of death on the death certificates. Despite the limitations of a retrospective investigation, it is concluded that the vital statistics of the Danish Board of Health underestimate the genuine number of cases. The range of indications for prophylaxis of thrombosis is possibly too narrow. LE should be considered in the differential diagnosis more frequently, particularly in elderly immobilized patients.