title: Thrombocytosis is Predictive of Postoperative Pulmonary Embolism in Patients With Gynecologic Cancer.
abstract: OBJECTIVE
  The prompt diagnosis of postoperative pulmonary embolism (PE) in gynecologic oncology patients is imperative, but the clinical presentation is nonspecific in this high-risk group. We sought to determine risk factors and clinical findings that may assist clinicians in diagnosing PE in the inpatient setting.
  
  
  METHODS
  Radiology data were queried to identify patients with gynecologic cancer who had a postoperative PE evaluation with computed tomography pulmonary angiography (CT-PA). Patient clinical findings at the time of the PE evaluation were abstracted, and univariate and multivariate regression analyses were performed to identify predictors of PE.
  
  
  RESULTS
  For 6 years, there were 2498 major gynecologic oncology surgical procedures performed at our institution. Within 14 days of surgery, 107 CT-PA studies were obtained with a positive study rate of 24.3%. In patients with and without PE, there was no significant difference noted for age, oxygen saturations, body mass index and heart rate. After controlling for stage, history of venous thromboembolism (VTE), heart rate, and oxygen saturation, platelet count (odds ratio, 1.26 per 50 counts increase; 95% confidence interval, 1.07-1.48; P = 0.006) and history of VTE (odds ratio, 17.1; 95% confidence interval, 1.77-Inf, P = 0.014) were identified as independent predictors of PE in the multivariate model.
  
  
  CONCLUSIONS
  Although clinicians often use tachycardia and low oxygen saturation as triggers to order PE imaging studies, these signs have a very low specificity. Given the findings of our study, accounting for high platelet count and history of VTE increases the pretest probability of CT-PA study.
authors.affiliation: *University of Minnesota Minneapolis, MN; †University of Wisconsin Hospitals and Clinics, Madison, WI; and ‡University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Cassandra L
authors.initials: CL
authors.lastname: Albertin
authors.forename: Shitanshu
authors.initials: S
authors.lastname: Uppal
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Al-Niaimi
authors.forename: Songwon
authors.initials: S
authors.lastname: Seo
authors.forename: James Louis
authors.initials: JL
authors.lastname: Hinshaw
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Hartenbach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013922:Thrombocytosis / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D055815:Young Adult