Anesth Pain Med.  2023 Jul;18(3):290-295. 10.17085/apm.23009.

Anesthetic management of an elderly COVID-19 patient with pulmonary thromboembolism for hip surgery - A case report -

• Heo MH
• Choi HY
• Kim JY
• Kim KW
• Lee SI
• Kim KT
• Park JS
• Choe WJ
• Kim JH

• KMID: 2547038
• DOI: http://doi.org/10.17085/apm.23009

Abstract

Background
COVID-19 and delayed hip surgery are well-known risk factors for thromboembolism in elderly patients. Case: We report the case of an 88-year-old female patient with COVID-19 and pulmonary thromboembolism (PTE) who underwent delayed hip surgery 21 days after the injury. Heparinization and inferior vena cava filters were used to treat and prevent PTE. Transesophageal echocardiography and extracorporeal membrane oxygenation (ECMO) sheaths were inserted as a precaution in case of emergencies during surgery; the procedure was performed without any specific event.
Conclusions
COVID-19-infected patients suffering from a hip fracture have a high risk of thromboembolism, and therefore, require utmost attention for appropriate evaluation and prevention.

Keyword

Aged; COVID-19; Hip fractures; Inferior vena cava filter; Pulmonary thromboembolism; Surgical procedures

Figure

• 

  Fig. 1. Diffuse pulmonary thromboembolism in left main (A, B), and right main (C) pulmonary artery on chest computed tomography (arrows: filling defects by thrombus).

• 

  Fig. 2. A fluoroscopic image was taken during the inferior vena cava filter insertion procedure.

Reference

1. HIP ATTACK Investigators. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet. 2020; 395:698–708.

2. Smith EB, Parvizi J, Purtill JJ. Delayed surgery for patients with femur and hip fractures-risk of deep venous thrombsis. J Trauma. 2011; 70:E113–6.

3. Kim KK, Lee SW, Choi JK, Won YY. Epidemiology and postoperative complications of hip fracture during COVID-19 pandemic. Osteoporos Sarcopenia. 2022; 8:17–23.

4. Sakr Y, Giovini M, Leone M, Pizzilli G, Kortgen A, Bauer M, et al. Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review. Ann Intensive Care. 2020; 10:124.

5. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020; 41:543–603.

6. Zhang Z, Shen B, Yang J, Zhou Z, Kang P, Pei F. Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. BMC Musculoskelet Disord. 2015; 16:24.

7. Roncon L, Zuin M, Barco S, Valerio L, Zuliani G, Zonzin P, et al. Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis. Eur J Intern Med. 2020; 82:29–37.

8. Huang CB, Hong CX, Xu TH, Zhao DY, Wu ZY, Chen L, et al. Risk factors for pulmonary embolism in ICU patients: a retrospective cohort study from the MIMIC-III database. Clin Appl Thromb Hemost. 2022; 28:10760296211073924.

9. Miró Ò, Jiménez S, Mebazaa A, Freund Y, Burillo-Putze G, Martín A, et al. Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome. Eur Heart J. 2021; 42:3127–42.

10. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020; 75:2950–73.

11. Jarvis S, Salottolo K, Madayag R, Pekarek J, Nwafo N, Wessel A, et al. Delayed hospital admission for traumatic hip fractures during the COVID-19 pandemic. J Orthop Surg Res. 2021; 16:237.

12. Tripathy SK, Varghese P, Panigrahi S, Panda BB, Velagada S, Sahoo SS, et al. Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis. World J Orthop. 2021; 12:35–50.

13. Villa JM, Pannu TS, Piuzzi NS, Krebs V, Riesgo AM, Higuera CA. A major increase of thromboembolic events in total hip and knee arthroplasty patients during the COVID-19 pandemic. Hosp Pract (1995). 2022; 50:68–74.

14. Cuthbert R, Ferguson D, Kayani B, Haque S, Ali A, Parkar A, et al. Evidence-based approach to providing informed consent for hip fracture surgery during the COVID-19 era. World J Orthop. 2021; 12:386–94.

15. Weinstein T, Deshwal H, Brosnahan SB. Advanced management of intermediate-high risk pulmonary embolism. Crit Care. 2021; 25:311.