[Incidence and characteristics of perioperative pulmonary thromboembolism in Japan in 2003]

Abstract

Background: Pulmonary thromboembolism (PTE) is increasingly recognized as a significant perioperative complication in Japan. A recent study reported that the incidence was 0.32 patients per 10,000 people per year in Japan. The aim of this investigation is to elucidate the incidence and characteristics of perioperative pulmonary thromboembolism in Japan.

Methods: A questionnaire was mailed to 844 institutions registered under the Japanese Society of Anesthesiologists (JSA). The survey details included age, sex, type of surgery, and risk factors of the cases operated in 2003.

Results: Among the 844 institutions, 504 (59.7%) responded effectively. There were 440 cases of perioperative PTE in 230 institutions (45.6% of the institutions responded). The incidence of perioperative PTE was 4.76 per 10,000 cases. Massive PTE or cardiac arrest at the onset occurred in 60 cases (13.7%). Among these patients, 178 (40.5%) were obese, 162 (36.8%) had malignant diseases, and 111 (25.2%) were bed-ridden (> 4 days). The types of surgery that resulted in PTE with high frequency were "limbs and/or hip joint surgery" (9.0 per cases), "thoracic surgery with laparotomy" (7.6 per 10,000 cases), and "abdominal surgery" (6.6 per 10,000 cases). Eighty-three patients died from perioperative PTE; out of these, 9 (10.8%) died during operation, 23 (27.7%) died within 3 days after the operation, and 51 (61.4%) died 4 days after the operation. Despite having risk factors, 80 patients (33. 9%) either received unrecommended measures or did not receive any preventive measures for PTE.

Conclusions: The incidence of perioperative PTE is not low in Japan and is 13 times higher than the rate observed in the general population. The use of thromboprophylaxis should be considered in patients with risk factors.