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A clinico pathological study of fatal pulmonary embolism in a specialist orthopedic hospital

A clinico pathological study of fatal pulmonary embolism in a specialist orthopedic hospital

Archives of Orthopaedic and Traumatic Surgery 99(1): 65-71

A study of post-mortem examinations performed between 1970 and 1979 at a specialist orthopedic hospital revealed that the overall mortality rate due to pulmonary embolism was 0.23% and that pulmonary embolism was responsible for 19.1% of hospital deaths. The majority of these fatalities occurred following operation for either fractured proximal femur or total hip replacement. During the decade, 928 patients were operated upon for fractured proximal femur; none received prophylactic anticoagulation therapy and the mortality rate due to pulmonary embolism was 17.7%. The yearly mortality rate decreased with time, and this change was attributed to earlier operation and early mobilization. Over the same period, 3016 patients underwent total hip replacement, 20% were anticoagulated prophylactically; the mortality rate due to pulmonary embolism was 0.63%. In patients who died of pulmonary embolism, post-mortem evidence of deep vein thrombosis was usually found, but no relationship between site of thrombosis and side of operation was observed. Pulmonary embolism was diagnosed in only a few patients, although on later consideration at least 1/3 of patients had symptoms suggestive of previous emboli. Possible improvements in diagnosis are discussed and a more rational approch to prophylactic anticoagulation suggested.

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Accession: 004556320

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PMID: 6172091

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