Abstract
BackgroundPulmonary embolism (PE) is a life-threatening condition common after major surgery. Although the high incidence (0.3–30%) and mortality rate (16.9–31%) of PE in patients undergoing major surgical procedures is apparent from findings of contemporary observational studies, there is a lack of a summary and meta-analysis data on the epidemiology of postoperative PE in this same regard. Hence, we propose to conduct the first systematic review to summarise existing data on the global incidence, determinants and case fatality rate of PE following major surgery.MethodsElectronic databases including MEDLINE, EMBASE, SCOPUS, WHO global health library (including LILACS), Web of Science and Google scholar from inception to April 30, 2017, will be searched for cohort studies reporting on the incidence, determinants and case fatality rate of PE occurring after major surgery. Data from grey literature will also be assessed. Two investigators will independently perform study selection and data extraction. Included studies will be evaluated for risk of bias. Appropriate meta-analytic methods will be used to pool incidence and case fatality rate estimates from studies with identical features, globally and by subgroups of major surgical procedures. Random-effects and risk ratio with 95% confidence interval will be used to summarise determinants and predictors of mortality of PE in patients undergoing major surgery.DiscussionThis systematic review and meta-analysis will provide the most up-to-date epidemiology of PE in patients undergoing major surgery to inform health authorities and identify further research topics based on the remaining knowledge gaps.Systematic review registrationPROSPERO CRD42017065126
Highlights
Pulmonary embolism (PE) is a life-threatening condition common after major surgery
The pathogenesis involves the interplay of an acute inflammatory reaction triggered by vascular endothelial lesions due to surgical dissections [6], hypercoagulability induced by surgical stress and anaesthetic drugs [7, 8], and venous stasis due to perioperative immobilisation and delayed rehabilitation, all described by Virchow more than a century ago [9]
PE is known to be relatively frequent during major surgery, where the following incidence rates have been reported: 0.7–30% after
Summary
The high incidence (0.3–30%) and mortality rate (16.9–31%) of PE in patients undergoing major surgical procedures is apparent from findings of contemporary observational studies, there is a lack of a summary and meta-analysis data on the epidemiology of postoperative PE in this same regard. We propose to conduct the first systematic review to summarise existing data on the global incidence, determinants and case fatality rate of PE following major surgery. About 234 million major surgical interventions are performed each year [1] and postoperative complications inflict a significant morbidity, mortality and economic burden to surgical patients as well as healthcare systems [2, 3]. Pulmonary embolism (PE), a lifethreatening complication of venous thromboembolism (VTE), represents a major postoperative complication [4]. Despite the widespread adoption of thromboembolic prophylactic measures, PE accounts for a 30-day major surgery-specific case fatality rate ranging between 16.9 and 31% [13, 21,22,23] and a 37% [21] 1year case fatality rate following major surgery
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