Long distance travel prior to major surgical procedure: Does it have an impact on post operative pulmonary embolism

Abstract

BACKGROUND: Long distance travel is a known risk factor for venous thrombo-embolism. In our hospital approximately 15% of surgical procedures are performed on patients from the country, needing prolong travel. The purpose of this study is to evaluate whether prolong travel prior to a surgical procedure increases the risk for post operative pulmonary embolism (PE). METHODS AND MATERIALS: Thirty patients with post operative pulmonary embolism confirmed by Computed Tomography Pulmonary Angiogram (CTPA), perfusion scan or by post-mortem, diagnosed during the same hospital admission were evaluated. Patients were categorised in to two groups, who travelled from the country or from metropolitan area in view of hospital admission. RESULTS: Operations in 25 metropolitan patients (12 males, 13 females, median age:71years, range:25-97, median distance:26km, range:5-55), and in five country patients (four males, one female, median age:65, range:33-73, median distance:183km, range:133-425) were complicated by post operative PE. Whilst 17 of 25 metropolitan patients (68%) received peri-operative prophylaxis against DVT/PE (pre-operatively or within 24hours of procedure), four of five patients (80%) from the country received prophylaxis. CONCLUSIONS: Long-distance travel prior to hospital admission seems to have no impact on the incidence of postoperative PE, as the proportion of country patients with postoperative PE (15%) is comparable to the proportion of country patients operated in a metropolitan hospital. Therefore the current policy of perioperative prophylaxis is adequate. Extended prophylaxis prior to initiation of travel seems unnecessary. © 2009 Indian Association of Cardiovascular-Thoracic Surgeons. AUTHOR KEYWORDS: Computed tomography; Pulmonary embolism; Surgery