Intermittent pneumatic compression for prevention of pulmonary thromboembolism after gynecologic surgery

A total of 6,218 patients operated at Keio University Hospital excluding obstetric or infertility-related surgery and uterine cervical conization were evaluated retrospectively to determine the preventive effect of intermittent pneumatic compression on postoperative pulmonary embolism.Pulmonary embolism occurred in 42 patients (0.68%). Multivariate analysis showed that malignancy, blood transfusion, and a body mass index ≥25 kg/m2 or ≥28 kg/m2 were independent risk factors for postoperative pulmonary embolism. A significantly lower incidence of pulmonary embolism occurred in patients receiving pneumatic compression postoperatively versus those without it. Among gynecologic malignancies, endometrial cancer was a significant risk factor for pulmonary embolism.Preventive measures, including intermittent pneumatic compression, should be taken to avoid postoperative pulmonary thromboembolism in the gynecology field.Previously, postoperative venous thromboembolism (VTE) did not attract much attention in Japan because its incidence was lower than in the USA and Europe [1]. However, an increasing number of patients have recently been diagnosed with VTE in Japan along with improved detection thanks to progress in imaging technologies and increasing medical interest in VTE. VTE is associated with pulmonary thromboembolism (PTE), which causes death in nearly 50% of patients if untreated and which appears to be caused by embolism arising from deep venous thrombosis. According to the statistics compiled by the Japanese Ministry of Health, Labor and Welfare, the number of deaths due to PTE increased more than 10-fold from 1951 to 2000 [2]. However, a recent report estimated the annual number of PTE patients in Japan at 3,492, which is approximately 1/25 of the number in the USA [3]. Prevention of VTE has been studied intensively in the USA and Europe since the American College of Chest Physicians (ACCP) Consensus Conference was held in 1985. Development of guidelines for the prev