title: Early Identification of Asymptomatic Pulmonary Embolism Proximal to the Subsegmental Arteries After Gynecologic Surgery.
abstract: Few studies have assessed whether cases of asymptomatic pulmonary embolism (PE) in the early postoperative phase are subsegmental versus more proximal. In this study, we investigated whether asymptomatic PE occurring just after gynecologic surgery was subsegmental, and we examined the background characteristics of patients who experienced PE within 2 months postoperatively. All hospital records were reviewed, yielding a total of 2052 women who had undergone surgeries performed by the gynecologic oncology team between 2003 and 2013 in the National Kyushu Cancer Center. Asymptomatic and symptomatic postoperative PE cases diagnosed by multidetector computed tomography angiography or lung scan were identified; after excluding 2 cases of preoperative PE, there were 15 (0.73%) cases of postoperative PE among 2050 women. Of the 15 cases, 9 (60%) were diagnosed on postoperative day 1 or 2. Of the 9 women, 4 had no or minor symptoms/signs other than decreased oxygen saturation as measured by pulse oximetry (Spo 2), and PE was segmental or more proximal in 3 cases. Only 1 of the 9 cases showed dyspnea. The remaining 4 cases showed dizziness or perspiration, suggesting PE. Univariate analysis showed age, operation time, hypertension, and preoperative d-dimer elevation to be associated with postoperative PE. Multivariate analysis demonstrated that a high (≥ 1 µg/mL) preoperative d-dimer level was associated with postoperative PE (odds ratio, 6.331; 95% confidence interval, 1.567-25.589). Most asymptomatic PE cases occurring within 2 days postoperatively were segmental or more proximal. Identification of early, asymptomatic postoperative PE may be clinically significant because most of these emboli are proximal to the subsegmental arteries.
authors.affiliation: Gynecology Service, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan okadome.m@nk-cc.go.jp.
authors.forename: Masao
authors.initials: M
authors.lastname: Okadome
authors.affiliation: Gynecology Service, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Saito
authors.affiliation: Gynecology Service, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan.
authors.forename: Kumi
authors.initials: K
authors.lastname: Shimamoto
authors.affiliation: Department of Anesthesiology, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan.
authors.forename: Rihoko
authors.initials: R
authors.lastname: Ogahara
authors.affiliation: Department of Anesthesiology, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Akiyoshi
authors.affiliation: Department of Anesthesiology, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Fujimoto
authors.affiliation: Department of Radiology, National Kyushu Cancer Center, Minami-ku, Fukuoka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Shinozaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: gynecologic surgery; perioperative management; pulmonary embolism; subsegmental artery