Surgery Increases Risk for Pulmonary Embolism Up to 12 Weeks After Operation

Pulmonary Embolism
Pulmonary Embolism
More trials are needed to evaluate whether the duration of postoperative prophylactic anticoagulation should be extended and to define its optimal duration.

There is an increased risk for pulmonary embolism (PE) more than 6 weeks after surgery among middle-aged patients without cancer, study results in JAMA suggest. Moreover, this increased risk for PE was irrespective of surgery type.

A case-crossover analysis of data from a French national inpatient database was performed, with a focus on the associated risk for postoperative PE with 6 types of surgery. The database covers approximately 203 million inpatient stays between 2007 and 2014. Patients included in the analysis were free from cancer and were aged 45 to 64 years. A total of 60,703 patients were included in the analysis (mean [SD] age, 56.6 [6.0] years).

The 6 different surgical procedures included vascular surgery, gynecologic surgery, gastrointestinal surgery, hip or knee replacement, fractures, and other orthopedic operations. The main outcome for the analysis was the diagnosis of a first PE.

Each type of surgery was associated with an increased risk for PE approximately 6 weeks after the intervention, ranging from vascular surgery (odds ratio [OR], 5.24; 95% CI, 3.91-7.01) to surgery for fractures (OR, 8.34; 95% CI, 6.07-11.45). Gynecologic surgery had the second-highest risk for early postoperative PE (OR, 8.17; 95% CI, 5.19-12.86). There was a persistently elevated risk for postoperative PE from 7 weeks to 12 weeks with each operation, ranging from gastrointestinal operations (OR, 2.26; 95% CI, 1.81-2.82) to surgery for fractures (OR, 4.23; 95% CI, 3.01-5.92). There was no clinically significant postoperative PE risk elevation for any surgery beyond 18 weeks.

Related Articles

Limitations of the study included the analysis of a broad range of surgery types as well as the lack of data on the types of drugs administered to patients during their hospital stay.

The researchers added that additional investigation into the benefit-to-risk ratio of extending prophylactic anticoagulation beyond 5 weeks after surgery and the defining of “the optimal duration of treatment with regard to both the thrombotic and bleeding risks” may be recommended.


Caron A, Depas N, Chazard E, et al. Risk of pulmonary embolism more than 6 weeks after surgery among cancer-free middle-aged patients [published online October 9, 2019]. JAMA Surg. doi:10.1001/jamasurg.2019.3742