Use of Helical CT Is Associated with an Increased Incidence of Postoperative Pulmonary Emboli in Cancer Patients with No Change in the Number of Fatal Pulmonary Emboli
ABSTRACT Multidetector computed tomography (MDCT) scanning technology has increased the ease with which pulmonary emboli (PE) are evaluated. Our aim was to determine whether the incidence and severity of postoperative PE have changed since adoption of multidetector computed tomography.
A prospective postoperative morbidity and mortality database from a single institution was used to identify all cancer patients who experienced a PE within 30 days of thoracic, abdominal, or pelvic operations. The incidence, type (central, segmental, and subsegmental), and severity of PE were examined.
A total of 295 PE were documented among 47,601 postoperative cancer patients. The incidence of PE increased yearly from 2.3 per 1,000 patients in 2000 to 9.3 per 1,000 patients in 2005 (p < 0.0001). This corresponded to an increasing number of CT scans of the chest performed (6.6 CT scans per 1,000 postoperative patients in 2000 versus 45 in 2005; p < 0.0001). The increased incidence was because of a 7.8% (CI, 4.0 to 11.7) and 5.4% (CI, 4.1 to 6.7) average annual increase in segmental and subsegmental PE, respectively. There was no change in the number of central (0.1%; CI, -1.0 to 1.12) PE. Overall incidence of fatal PE was 0.4 and did not change during the time period (p = 0.3). A central PE was more commonly associated with hypoxia, ICU admission, and 30-day mortality (33% versus 5% for peripheral; p = 0.02).
Chest CT scans are being performed more frequently on postoperative cancer patients and have resulted in an increased diagnosis of peripheral PE. The clinical significance of, and optimal treatment for, diagnosed subsegmental PE are incompletely defined.
[Show abstract] [Hide abstract]
ABSTRACT: Computed tomographic pulmonary angiography (CTPA) has a high sensitivity for diagnosing filling defects in subsegmental pulmonary arteries. The adoption of CTPA as the prefered diagnostic modality for the diagnosis of pulmonary embolism (PE) has led to an increased rate of PE diagnosis. However, the case fatality rate is lower and the mortality rate of PE has remained unchanged despite this rise in PE diagnosis suggesting that the disease is of lesser severity. There continues to be clinical equipoise on whether patients diagnosed with isolated subsegmental PE (SSPE) require anticoagulation or can be managed conservatively if the presence of deep vein thrombosis (DVT) has been excluded. Recent recommendations from the European Society of Cardiology suggest an individualized approach for the management of patients with newly diagnosed SSPE based on the risk/benefit ratio of anticoagulation and the presence of lower limb DVT. Prospective data evaluating the safety and efficacy of management strategies for SSPE is needed in order to determine the optimal management of these patients.Journal of Thrombosis and Thrombolysis 04/2015; 39(3). DOI:10.1007/s11239-015-1169-7 · 2.04 Impact Factor
Imaging 05/2013; 22(1):20100064. DOI:10.1259/imaging.20100064
[Show abstract] [Hide abstract]
ABSTRACT: Background The accuracy of CT pulmonary angiography (CTPA) in detecting or excluding pulmonary embolism has not yet been assessed in patients with high body weight (BW). Methods This retrospective study involved CTPAs of 114 patients weighing 75–99 kg and those of 123 consecutive patients weighing 100–150 kg. Three independent blinded radiologists analyzed all examinations in randomized order. Readers' data on pulmonary emboli were compared with a composite reference standard, comprising clinical probability, reference CTPA result, additional imaging when performed and 90-day follow-up. Results in both BW groups and in two body mass index (BMI) groups (BMI < 30 kg/m2 and BMI ≥ 30 kg/m2, i.e., non-obese and obese patients) were compared. Results The prevalence of pulmonary embolism was not significantly different in the BW groups (P = 1.0). The reference CTPA result was positive in 23 of 114 patients in the 75–99 kg group and in 25 of 123 patients in the ≥ 100 kg group, respectively (odds ratio, 0.991; 95% confidence interval, 0.501 to 1.957; P = 1.0). No pulmonary embolism-related death or venous thromboembolism occurred during follow-up. The mean accuracy of three readers was 91.5% in the 75–99 kg group and 89.9% in the ≥ 100 kg group (odds ratio, 1.207; 95% confidence interval, 0.451 to 3.255; P = 0.495), and 89.9% in non-obese patients and 91.2% in obese patients (odds ratio, 0.853; 95% confidence interval, 0.317 to 2.319; P = 0.816). Conclusion The diagnostic accuracy of CTPA in patients weighing 75–99 kg or 100–150 kg proved not to be significantly different.European Journal of Internal Medicine 10/2014; 25(8). DOI:10.1016/j.ejim.2014.07.003 · 2.30 Impact Factor