"We anticipated the incidence of PE after knee arthroscopies would be low but we wanted to uncover exactly what risk patients were undergoing and who might be at increased risk," said Iftach Hetsroni, MD, study author and orthopaedic surgeon, Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel.
The study, performed at Hospital for Special Surgery, New York, examined data on 374,033 patients undergoing 418,323 outpatient arthroscopic knee procedures between 1997 and 2006 as recorded in the New York State Department of Health Statewide Planning and Research Cooperative System administrative database. Cases were defined as hospital readmission within 90 days of arthroscopic procedure with a diagnosis of PE. There were 117 PE cases (.028 percent) with one reported death.
The study identified several risk factors:
- Patients 30 years and older are six times more at risk than patients younger than twenty years.
- Operating room time greater than 90 minutes is associated with three times more risk compared to procedures less than 30 minutes.
- Females are 1.5 times more at risk than males.
- History of cancer is associated with three times more risk.
Anesthesia type, complexity of surgery (i.e. reconstruction of the anterior cruciate ligament or meniscus repair as compared to simple meniscectomy), or other existing conditions were not proven to increase a patient's risk of PE.
"While knee arthroscopy performed as an outpatient seems like an innocent procedure, patients with one or more of these risk factors should talk with their doctors about any precautions before or after surgery," explained Dr. Hetsroni. "For example, our study may encourage some surgeons to consider thromboprophylaxis, or blood-thinning techniques, for patients who have multiple risk factors."
Patients should watch for several complications and warning signs and seek medical care immediately if they are experiencing any PE symptoms such as chest discomfort or palpitations. Most PEs occur seven to 10 days after surgery and typically prior to three months post surgery.
"Athletes should understand that while a pulmonary embolism after knee arthroscopy is extremely rare, it can happen and lead to serious complications," said Dr. Hetsroni.
More about knee arthroscopy and PE:
More than 4 million knee arthroscopies are performed worldwide each year according to the American Orthopaedic Society for Sports Medicine.
Arthroscopy is a common surgical procedure in which a joint (arthro-) is viewed (-scopy) using a small camera. Arthroscopy gives doctors a clear view of the inside of the knee. It helps him or her diagnose and treat knee problems such as torn cartilage, torn ligaments and inflamed tissue.
Pulmonary embolisms occur when blockage, such as a clot, travels from elsewhere in the body to the lungs. The obstruction of the blood flow through the lungs puts pressure on the heart which leads to the symptoms and signs of PE. These symptoms include difficulty breathing, chest pain and palpitations. Severe cases of PE can lead to death.
Source:
American Academy of Orthopaedic Surgeons
New Medical Students Begin The University Year With An Uncertain Future, Australia
The Australian Medical Students' Association (AMSA) congratulates the nearly 3500 students who today will embark on their first day of medical school, but calls for urgent action on medical training to ensure these students become quality doctors.
In response to a nationwide doctor shortage and Australia's ageing population, recent federal governments have rightly increased medical student numbers. This was achieved by increasing the capacity of existing medical schools as well as creating new medical schools. As a result, the number of commencing medical students has grown by nearly 30% in the past 5 years and this continues to place pressure on the training capacity of our health system.
AMSA President Robert Marshall said today that, despite a need for more doctors, poor planning has meant that medical student numbers have reached crisis point and cannot continue to be increased without risking the quality of medical education.
"AMSA believes that, with the vast increase in medical student numbers, measures must be taken to ensure that the quality of medical education in Australia is maintained. This is especially relevant in clinical settings where there is still an 'apprentice' model of learning. Without more investment in clinical training and resources, quality will be compromised.
"Medical students often feel like senior doctors are frequently too busy with clinical responsibilities to adequately teach them. In order to ensure a system that permits time for teaching, Governments must prioritise the creation and maintenance of adequate staff levels at hospitals and universities.
"While utilising facilities such as private hospitals can be useful in some instances, they cannot replace the core training facilities currently being overwhelmed by student numbers. An increase in funding allocated to improving and upgrading core training facilities in medical schools and public teaching hospitals is urgently required.
"However, governments must also ensure that all medical graduates have a training place immediately after graduation, as one in four graduates are not currently guaranteed an internship. Without an internship, graduates are unable to gain full registration and progress to any kind of further medical training," Mr Marshall said.
AMSA calls for the Government to place a cap on medical student numbers and new medical schools until all medical students (both domestic and international) who are already in the system are guaranteed quality clinical training and an internship upon graduation.
Source:
Australian Medical Students' Association (AMSA)
