Postoperative Pulmonary Embolism Rate Is High Among Cancer-Free, Middle-Aged Patients

Among cancer-free patients, the risk of postoperative pulmonary embolism is elevated beyond six weeks post-surgery regardless of the type of procedure, according to a study published in JAMA Surgery.

This study was a case-crossover analysis of 60,673 patients from a French national inpatient database comprised of a total of 203 million inpatient stays over an 8-year period (2007-2014). The study subjects of interest were all cancer-free middle-aged patients between the ages of 45 and 64 with a diagnosis of a first pulmonary embolism. The study classified surgical procedures into six categories: 1) vascular surgery, 2) gynecological surgery, 3) gastrointestinal surgery 4) hip or knee replacement, 5), as well as 6) other orthopedic operations. The study’s key endpoint was an initial diagnosis of pulmonary embolism.

The results showed that the risk of postoperative pulmonary embolism was higher for at least 12 weeks after all types of surgery and was highest during the immediate postoperative period (1 to 6 weeks). Moreover, the researchers observed an excess risk of postoperative pulmonary embolism ranged from odds ratio (OR), 5.24 (95% CI, 3.91 to 7.01) for vascular surgery to OR, 8.34 (95% CI, 6.07 to 11.45) for surgery for fractures. The findings showed the risk remained elevated from 7 to 12 weeks, with the OR ranging from 2.26 (95% CI, 1.81-2.82) for gastrointestinal operations to 4.23 (95% CI, 3.01 to 5.92) for surgery for fractures. The risk was deemed clinically insignificant beyond 18 weeks post-surgery for all types of procedures.

Risk of Pulmonary Embolism After Surgery Among Cancer-Free Middle-aged Patients https://t.co/sPiSrRBggu @JAMASurgery

— Steven D Wexner MD, PhD (@SWexner) October 10, 2019

“The persistence of this excess risk suggests that further randomized clinical trials are required to evaluate whether the duration of postoperative prophylactic anticoagulation should be extended and to define the optimal duration of treatment with regard to both the thrombotic and bleeding risks,” the authors wrote in their conclusion.

"The risk of postop PE is elevated beyond 6 weeks regardless of procedure… further trials are required to evaluate whether prophylactic anticoag should be extended…"

We already anticoagulate post colon cancer surgery… maybe we should be treating more outpatients postop? https://t.co/9Hc8WQry6M

— Edward Jones MD, FACS, FASGE (@edwardljonesII) October 10, 2019

The risk of postoperative pulmonary embolism is elevated beyond 6 weeks postsurgery regardless of the type of procedure. The risk remained elevated from 7 to 12 weeks after all type of surgical procedures. It is not significant after 18 weeks.
https://t.co/GC2BbkDJ20

— George Ferzli (@drferzli) October 14, 2019