One-Year All-Cause Mortality of Patients Diagnosed as Having In-Hospital Pulmonary Embolism After Modern Elective Joint Arthroplasty Is Low And Unaffected By Radiologic Severity

• Published in: The Journal of arthroplasty 2016-02, Vol.31 (2), p.473-479
• Main Authors: Gonzalez Della Valle, Alejandro, MD, Lee, Yuo-yu, MS, Saboeiro, Gregory, MD, Konin, Gabrielle P., MD, Endo, Yoshimi, MD, Robador, Nicolas, MD, Di Nallo, Martin, MD, Westrich, Geoffrey H., MD, Salvati, Eduardo A., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; bleeding complications; Comorbidity; computed tomography; Elective Surgical Procedures - adverse effects; Female; Hospitals; Humans; Length of Stay; Lung - diagnostic imaging; Male; Middle Aged; mortality; New York City - epidemiology; Orthopedics; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Postoperative Complications - mortality; pulmonary embolism; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - etiology; Pulmonary Embolism - mortality; Radiography; re-admission; total joint arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2015.09.006

Abstract Background We studied the 1-year complication rate of patients diagnosed as having a pulmonary embolism (PE) after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgery and the distribution of emboli in the pulmonary circulation, and determined if a relationship exists between the location of the PE and age, gender, body mass index, preoperative predisposing factors, American Society of Anesthesiology classification, type of surgery, prophylaxis, hospital stay, transfer to a higher level of care, and mortality. Methods Two hundred sixty-nine patients who developed an in-hospital PE proved by computed tomography pulmonary angiography after elective THA or TKA between 2005 and 2012 were studied. Results The most proximal location of the emboli was central in 62, segmental in 139, and subsegmental in 68. Nineteen patients (7%) developed a bleeding complication during PE treatment. Twenty-nine patients (11%) were readmitted during the first year. Two patients (0.74%) died: one had a segmental PE after TKA. He died 11 months after surgery due to an autopsy-proven sepsis. The second patient developed a segmental PE after THA. She was anticoagulated, developed an intracranial bleed, and died 8 months after surgery. Multivariate analysis showed that demographic variables, American Society of Anesthesiology class, preoperative comorbidities (with the exception of arrhythmia), and the presence of preoperative predisposing factors had no effect in the location of the PE. Conclusion The 1-year mortality rate of these patients is low. Death can be caused by bleeding complications secondary to anticoagulation or by unrelated conditions. This information may aid clinicians while counseling patients who developed a PE after surgery, particularly those with small subsegmental emboli.