Postoperative pulmonary embolism in thoracic surgery and its prevention

Abstract

Because of the occurrence of 3 cases of postoperative pulmonary thromboembolism (PE) in 212 patients who underwent thoracic surgery between 1998 and 1999, we introduced a preventive strategy consisting of elastic stockings, intermittent pneumatic compression socks, and walking on postoperative day 1; we have experienced no symptomatic PE in 902 patients thereafter. For one year from June 2004, we tested a comprehensive protocol to evaluate the risk-level of PE and to detect deep vein thrombosis (DVT). D-dimer was determined as useful to rule out preoperative DVT. However, the clinical classification was not effective for selecting patients to be treated with heparin during the perioperative period, because 51 (75%) of 68 patients with a thoracic malignancy were selected as being at the highest risk.