title: Evaluation of the incidence of pulmonary embolus in the early postoperative period following cemented hemiarthroplasty.
abstract: OBJECTIVE
  Little is known regarding the incidence of early postoperative pulmonary embolus (PE) following hip fracture surgery. Clinical suspicion of PE mandates therapeutic anticoagulation, adding a further insult to those of trauma and surgery in a physiologically frail population. The aim of the study was to evaluate for the presence of PEs by performing postoperative CT pulmonary angiography (CTPA) in patients who demonstrated intraoperative, or early postoperative cardiorespiratory lability following surgery with a cemented prosthesis for intracapsular hip fracture.
  
  
  METHODS
  All patients undergoing cemented hemiarthroplasty for displaced intracapsular neck of femur fracture were recruited during a 6-month period, and signed consent obtained from the patient or their next of kin for CTPA in the event of any cardiorespiratory instability. Patient demographics, comorbidities were reviewed, and premorbid mobility status documented.
  
  
  RESULTS
  18 of the 66 patients in the study having cemented hemiarthropalsty demonstrated intra- or early postoperative lability, all had early postoperative CTPA scans. 6 of the 18 were noted to have PE. All had more than 1 risk factor for VTE on admission (excluding their injury). Patients diagnosed with PE had a higher ASA grade, and lower mobility scores than those who did not have a PE.
  
  
  CONCLUSIONS
  Clinical suspicion alone is inadequate to diagnosis PE in patients undergoing cemented hip arthroplasty. Only 1 in 3 patients suspected of PE on account of intraoperative or immediate postoperative cardiorespiratory lability was found to have a PE based on CTPA. Early postoperative CTPA is helpful to prevent unnecessary anticoagulation for suspected PE.
authors.affiliation: Department of Orthopaedics, St. Vincent's University Hospital, Dublin - Ireland.
authors.forename: Colin G
authors.initials: CG
authors.lastname: Murphy
authors.affiliation: Department of Radiology, St. Vincent's University Hospital, Dublin - Ireland.
authors.forename: Deirdre E
authors.initials: DE
authors.lastname: Moran
authors.affiliation: Department of Radiology, St. Vincent's University Hospital, Dublin - Ireland.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Gerstenmaier
authors.affiliation: Department of Orthopaedics, St. Vincent's University Hospital, Dublin - Ireland.
authors.forename: Rob
authors.initials: R
authors.lastname: Bruce-Brand
authors.affiliation: Department of Orthopaedics, St. Vincent's University Hospital, Dublin - Ireland.
authors.forename: Gary C
authors.initials: GC
authors.lastname: O'Toole
authors.affiliation: Department of Orthopaedics, St. Vincent's University Hospital, Dublin - Ireland.
authors.forename: S Kieran
authors.initials: SK
authors.lastname: O'Rourke
authors.affiliation: Department of Radiology, St. Vincent's University Hospital, Dublin - Ireland.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Heffernan
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002484:Cementation / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000009:adverse effects* / Q000379:methods; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D011184:Postoperative Period; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome