Middle-aged patients without a history of cancer may experience elevated risk for pulmonary embolism (PE) up to 18 weeks following surgery, according to research published in JAMA Surgery.

Researchers conducted a retrospective case-crossover study using patient records from the French national inpatient database. The case-crossover design allowed the researchers to control for time-constant variables such as age and sex. Patients were between the ages of 45 and 64 years, did not have a history of cancer, and were admitted to an emergency department or hospital for PE between January 1, 2009, and December 31, 2014. A total of 60,703 patients were included in the study.

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The researchers separated surgical procedures into 6 categories: vascular surgery, gynecological surgery, gastrointestinal surgery, hip or knee replacement, surgery for fractures, and other orthopedic operations.

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For all surgical procedures, risk for PE was elevated for at least 12 weeks. During the first 6 weeks after surgery, odds ratios (ORs) for postoperative risk ranged from 5.24 (95% CI, 3.91-7.01) for vascular surgery to 8.34 (95% CI, 6.07-11.45) for surgery for fractures. At 7 to 12 weeks after surgery, ORs ranged from 2.26 (95% CI, 1.81-2.82) for gastrointestinal surgery to 4.23 (95% CI, 3.01-5.92) for surgery for fractures.

At 13 to 18 weeks after surgery, excess risk for postoperative PE (OR > 2) was seen with hip or knee replacement (OR, 2.26; 95% CI, 1.53-3.35), surgery for fractures (OR, 2.39; 95% CI, 1.65-3.46), and vascular surgery (OR, 2.64; 95% CI, 1.80-3.89). At 19 weeks after surgery and beyond, risk for postoperative PE was not significant for any category of surgery.

Current guidelines recommend administering prophylactic anticoagulation for up to 5 weeks following orthopedic procedures. However, the researchers suggested that the optimal duration of prophylaxis may need to be reconsidered. Further randomized clinical trials are warranted to assess the benefits and risks of extended prophylaxis with anticoagulation for patients undergoing surgical procedures.


1.     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