Kim Ho Cheol, Park Jin-Han, Song Jong-Min, Hwang Jae-Joon, Hong Sang-Bum, Oh Yeon-Mok, Lee Sang-Do, Lee Jae Seung
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
J Thorac Dis. 2020 Mar;12(3):232-239. doi: 10.21037/jtd.2020.01.54.
Preoperative pulmonary embolism (PE) is one of the comorbidities in patients with hip fracture. However, previous studies have not identified the optimal timing of surgery in these patients, who might require early surgery. This study aimed to investigate the safety and clinical feasibility of early surgery in patients with hip fracture and acute PE.
The medical records of 156 patients with hip fracture, who were suspected to have PE and underwent pulmonary computed tomography angiography at Asan Medical Center from January 2008 to December 2017, were retrospectively reviewed. After excluding patients who were diagnosed with PE during the postoperative period, the baseline characteristics and clinical course were compared between patients preoperatively diagnosed with PE (PE group) and patients without PE during the hospital stay (non-PE group). Adverse outcomes were evaluated during 3 months postoperatively.
The baseline characteristics were not different between the PE group (n=90) and the non-PE group (n=50). All patients in the PE group were classified as having an intermediate/low or low risk according to the European Society of Cardiology guidelines and underwent surgery within 30 days after the PE diagnosis (median duration: 2 days). None of the patients in both groups developed symptomatic venous thromboembolism (VTE) during the follow-up. Moreover, there were no statistically significant differences in major bleeding, clinically relevant nonmajor (CRNM) bleeding, transfusion amount, bleeding site, and length of hospital stay between the PE and non-PE groups.
Our results suggest that early surgery might be a reasonable treatment option in patients with hip fracture and acute PE.
术前肺栓塞（PE）是髋部骨折患者的合并症之一。然而，既往研究尚未确定这些可能需要早期手术的患者的最佳手术时机。本研究旨在探讨髋部骨折合并急性PE患者早期手术的安全性和临床可行性。
回顾性分析2008年1月至2017年12月在峨山医学中心疑似患有PE并接受肺部计算机断层扫描血管造影的156例髋部骨折患者的病历。排除术后诊断为PE的患者后，比较术前诊断为PE的患者（PE组）和住院期间未发生PE的患者（非PE组）的基线特征和临床过程。在术后3个月内评估不良结局。
PE组（n = 90）和非PE组（n = 50）的基线特征无差异。根据欧洲心脏病学会指南，PE组所有患者均被分类为中度/低度或低度风险，并在PE诊断后30天内接受手术（中位持续时间：2天）。两组患者在随访期间均未发生有症状的静脉血栓栓塞（VTE）。此外，PE组和非PE组在大出血、临床相关非大出血（CRNM）、输血量、出血部位和住院时间方面无统计学显著差异。
我们的结果表明，早期手术可能是髋部骨折合并急性PE患者的合理治疗选择。
