title: The Clinical Severity of Patients Diagnosed With an In-Hospital Pulmonary Embolism Following Modern, Elective Joint Arthroplasty Is Unrelated to the Location of Emboli in the Pulmonary Vasculature.
abstract: In the event of a postoperative pulmonary embolism (PE), it is generally believed that patients with centrally located emboli will have worse clinical symptoms than those with segmental or subsegmental ones. We studied if a relationship exists between the clinical severity at the time of PE diagnosis and the location of the emboli within the pulmonary vasculature.
  
  
  
  All 269 patients who developed an in-hospital, computed tomography pulmonary angiography-proved, PE following elective total hip arthroplasty or total knee arthroplasty in our institution were studied. The clinical severity of the PE was calculated using the Pulmonary Embolism Severity Index (PESI) that classifies patients in 5 classes (class 5: most severe). All computed tomography pulmonary angiographies were re-reviewed to determine the location of the emboli within the pulmonary vasculature (central, segmental, or subsegmental-unilateral or bilateral). The association between PESI and the PE location was examined.
  
  
  
  The most proximal location of the emboli was central in 62, segmental in 139, and subsegmental in 68. There were 180 unilateral and 89 bilateral PE patients. There was no association between the PESI and the location of the emboli within the pulmonary vasculature (P = .32). Patients with bilateral or unilateral lung involvement had similar PESI (P = .78).
  
  
  
  The PESI, a recognized, validated predictor of mortality after PE was similar in patients with central, segmental, or subsegmental PE; and in patients with unilateral or bilateral lung involvement. The present study may aid clinicians while assessing and discussing the severity of PE symptoms with patients at the time of diagnosis.
authors.affiliation: Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gonzalez Della Valle
authors.affiliation: Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Blanes Perez
authors.affiliation: Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Yuo-Yu
authors.initials: YY
authors.lastname: Lee
authors.affiliation: Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Saboeiro
authors.affiliation: Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Gabrielle P
authors.initials: GP
authors.lastname: Konin
authors.affiliation: Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Endo
authors.affiliation: Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Nigel E
authors.initials: NE
authors.lastname: Sharrock
authors.affiliation: Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Salvati
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D000072226:Computed Tomography Angiography; D017558:Elective Surgical Procedures; D005260:Female; D006761:Hospitals; D006801:Humans; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
keywords: clinical severity; mortality; pulmonary embolism; spiral CT scan; total joint arthroplasty