Thromboembolism causes important morbidity and mortality after pneumonectomy. Objectives of this study were to determine 1) the prevalence and timing of deep venous thrombosis (DVT) and pulmonary embolism (PE) following pneumonectomy, and 2) outcome.
From January 1990 to December 2000, 333 patients underwent pneumonectomy for malignancy. All received DVT prophylaxis (twice-daily subcutaneous heparin and compression stockings) that was continued to hospital discharge. Patients developing clinically evident DVT or PE were identified and their medical records reviewed.
Prevalence of DVT or PE was 25/333 (7.5%). Incidence peaked 7 days after pneumonectomy (Figure). 9 events occurred in-hospital, 8 within 15 days of discharge, and 8 thereafter to 55 months. 17 had DVT only, 5 had PE only, and 3 had both. 20 patients developed DVT in 33 locations, 15 in lower extremities, 14 in upper extremities, and 4 centrally. All patients were fully anticoagulated upon diagnosis. 2 patients with PE underwent thrombolysis. 8 patients were readmitted to the intensive care unit, and 7 were intubated. Survival at 6 months was 54%. Death was attributable to DVT or PE in 10 patients, malignancy in 6, and unknown causes in 6. Low preoperative forced vital capacity was highly predictive of poor long-term survival (P=.001).CONCLUSIONS: DVT and PE following pneumonectomy are poorly tolerated and, surprisingly, occur frequently early after hospital discharge.
Extending prophylaxis beyond hospital discharge warrants investigation.
M.M. DeCamp, None.