Abstract
Purpose
To determine 30-day mortality and predictors of mortality following perioperative pulmonary embolism (PE).
Methods
We searched both the Mayo Clinic electronic medical records and Autopsy Registry, between January 1, 1998 and December 31, 2001, for patients who developed PE within 30 days after noncardiac surgery performed under general or neuraxial anesthesia. Medical records of all identified patients were reviewed using standardized data collection forms. The association between risk factors for PE and 30-day post-PE mortality was assessed using t tests, exact binomial tests, and logistic regression.
Results
We identified 158 patients with probable or definite perioperative PE. The overall 30-day mortality from the day of PE was 25.3%, i.e., 40 patients died. Hypotension requiring treatment, need for mechanical ventilation, and intensive care unit admission were the prominent univariate predictors of 30-day mortality (all P ≤ 0.001). Other significant factors were exact bi normal tests, and higher ASA physical status (P = 0.002), longer surgical time (P = 0.030), recent central vein cannulation (P = 0.021) and intraoperative use of either blood transfusions or other blood products (P = 0.010). Using multi-variable analysis, hemodynamic instability was found to be the dominant independent risk factor associated with mortality.
Conclusions
Perioperative PE is associated with a high 30-day mortality. Patients who experience hemodynamic instability and require vasoactive treatment at presentation of PE have extremely low survival rates; therefore, for these patients the most aggressive therapeutic modalities should be considered.
Résumé
Objectif
Déterminer la mortalité à 30 jours et les indicateurs de mortalité suite aux embolies pulmonaires (PE) périopératoires.
Méthode
Nous avons consulté les dossiers médicaux électroniques de la clinique Mayo et son registre des autopsies pour la période allant du Ier janvier 1998 au 31 décembre 2001 afin de trouver les patients ayant développé une embolie pulmonaire dans les 30 jours suivant une chirurgie non cardiaque pratiquée sous anesthésie générale ou neuraxiale. Les dossiers médicaux de tous les patients identifiés comme tels ont été passés en revue à l’aide de formulaires de récolte de données standardisés. L’association entre les facteurs de risque d’une embolie pulmonaire et la mortalité dans les 30 jours suivant l’embolie a été évaluée par régression logistique.
Résultats
Nous avons identifié 158 patients avec une embolie pulmonaire périopératoire probable ou certaine. La mortalité totale à 30 jours depuis le jour de l’embolie pulmonaire était de 25,3 %, soit 40 décès. Une hypotension nécessitant un traitement, le besoin de ventilation mécanique et l’admission aux soins intensifs ont été les indicateurs univariés majeurs d’une mortalité à 30 jours (tous P ≤ 0,001). Un score ASA plus élevé (P = 0,002), une durée de chirurgie plus longue (P = 0,030), une canulation veineuse centrale récente (P = 0,021) et l’utilisation peropératoire de transfusions sanguines ou d’autres produits sanguins (P = 0,010) sont d’autres facteurs significatifs. L’instabilité hémodynamique a été déterminée comme le facteur de risque dominant associé à la mortalité, sur la base d’une analyse multivariable.
Conclusion
L’embolie pulmonaire périopératoire est associée à une mortalité à 30 jours élevée. Les patients souffrant d’instabilité hémodynamique et nécessitant un traitement vasomoteur lors de l’apparition de l’embolie pulmonaire présentent un taux de survie très bas; pour cette raison, les modalités thérapeutiques les plus agressives devraient être disponibles pour ces patients.
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Support provided by the Department of Anesthesiology, Mayo Clinic, Rochester, MN.
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Comfere, T.B., Sprung, J., Case, K.A. et al. Predictors of mortality following symptomatic pulmonary embolism in patients undergoing noncardiac surgery. Can J Anesth 54, 634–641 (2007). https://doi.org/10.1007/BF03022957
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DOI: https://doi.org/10.1007/BF03022957