Predictors of mortality following symptomatic pulmonary embolism in patients undergoing noncardiac surgery.
OBJECTIVE
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 <or= 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 multivariable 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.
Comfere
Thomas B
TB
Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Sprung
Juraj
J
Case
Kimberly A
KA
Dye
Paul T
PT
Johnson
Jamey L
JL
Hall
Brian A
BA
Schroeder
Darrell R
DR
Hanson
Andrew C
AC
Marienau
Mary E S
ME
Warner
David O
DO
D000368:Aged; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011655:Pulmonary Embolism / Q000401:mortality*; D012042:Registries; D012907:Smoking; D013514:Surgical Procedures, Operative; D013997:Time Factors