[Knowledge and lessons learned from the results of perioperative pulmonary thromboembolism research by the Japanese Society of Anesthesiologists (JSA-PPT Research)].
Knowledge and information were acquired from the results of the annual perioperative pulmonary thromboembolism (PPT) research from 2002 to 2004 by the Japanese Society of Anesthesiologists. Due to the popularization and use of prophylaxis, perioperative pulmonary thromboembolism (PPT) decreased significantly in 2004 compared to the years 2002 and 2003 (P < 0.001). The types of surgery with the highest incidence of PPT were hip/extremity surgery (7.48 per 10,000 cases), spinal surgery (6.30 per 10000 cases) and laparotomy (5.32 per 10,000 cases). Compared with minor surgery, relative risks were 3.4 [2.6-4.3 95% CI] in laparotomy, 4.0 [3.7-6.1 95% CI] in hip/extremity surgery and 4.8 [2.9-5.6 95% CI] in spinal surgery. The incidence of PPT in the elderly group (over 66 yrs) was higher than that of PPT in the middle age group (19-65 yrs). The mortality in the over 86 year old group was significantly higher than that of the middle age group. Our analysis shows that, at least, we need to start prevention of PPT from the preoperative period in lower limb/hip surgery, and start it from intra-/post operative period in laparotomy for malignancy. Three major risk factors, obesity (35.9%), malignancy (34.2%) and immobility (27.7%), were found in our research. The proportion of obese men (20-40 yrs) with PPT was 2 fold higher, and in women (20-50 yrs) it was three fold higher, than that of the general population. In our investigation, the mortality rate of the PPT patient without prophylaxis was significantly higher than that of the patient with prophylaxis (P < 0.01). The predictive factors for death in our logistic regression were male gender, immobility, and lack of prophylactic treatment.
Kuroiwa
Masayuki
M
Department of Anesthesiology, Kitasato University, School of Medicine, Sagamihara.
D000367:Age Factors; D000776:Anesthesiology; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D009765:Obesity; D016017:Odds Ratio; D019990:Perioperative Care; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D012955:Societies, Medical; D013514:Surgical Procedures, Operative; D015996:Survival Rate