Incidence and risk factors for pulmonary embolism after primary musculoskeletal tumor surgery.

BACKGROUND: Limited information is available regarding the incidence, risk factors, and optimal prophylaxis in orthopaedic oncology patients, although malignancy and major orthopaedic surgery are associated with an increased pulmonary embolism (PE) risk.

QUESTIONS/PURPOSES: We aimed to investigate the incidence of PE after musculoskeletal tumor surgery in Japanese patients and analyze the potential risk factors for PE.

METHODS: We retrospectively identified 3750 patients (1981 males, 1769 females) who underwent musculoskeletal tumor surgery during 2007 to 2010 using the Japanese Diagnostic Procedure Combination administrative database. Data collected included sex, age, primary diagnosis, type of surgery, duration of anesthesia, and comorbidities that may affect PE incidence. Univariate logistic regression analyses were performed to examine the relationship of each factor with PE occurrence.

RESULTS: We identified 10 patients with PE during the survey period. A primary malignant bone tumor was associated with a significantly higher risk of PE than a primary malignant soft tissue tumor (odds ratio [OR], 5.58; 95% CI, 1.39-22.42). Bone tumor resection (OR, 7.94; 95% CI, 1.77-35.59) and prosthetic reconstruction (OR, 9.15; 95% CI, 1.52-55.07) were associated with a significantly higher risk of PE than soft tissue tumor resection.

CONCLUSIONS: Malignant bone tumors and bone tumor resections have a higher risk of PE than malignant soft tissue neoplasms and soft tissue resections. Both populations might require PE prophylaxis as it is likely that the risk is greater than with other major orthopaedic surgery, but data accumulation should continue, and further investigation should be done to clarify details of the incidence, risk factors, and optimal prophylaxis for PE.

LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.