Importance The risk of postoperative pulmonary embolism has been reported to be highest during the first 5 weeks after surgery. However, how long the excess risk of postoperative pulmonary embolism persists remains unknown. Objective To assess the duration and magnitude of the late postoperative risk of pulmonary embolism among cancer-free middle-aged patients by the type of surgery. Design, Setting, and Participants Case-crossover analysis to compute the respective risks of pulmonary embolism after 6 types of surgery using data from a French national inpatient database, which covers a total of 203 million inpatient stays over an 8-year period between 2007 and 2014. Participants were cancer-free middle-aged adult patients (aged 45 to 64) with a diagnosis of a first pulmonary embolism. Exposures Hospital admission for surgery. Surgical procedures were classified into 6 types: (1) vascular surgery, (2) gynecological surgery, (3) gastrointestinal surgery, (4) hip or knee replacement, (5) fractures, and (6) other orthopedic operations. Main Outcomes and Measures Diagnosis of a first pulmonary embolism. Results A total of 60 703 patients were included (35 766 [58.9%] male; mean [SD] age, 56.6 [6.0] years). The risk of postoperative pulmonary embolism was elevated for at least 12 weeks after all types of surgery and was highest during the immediate postoperative period (1 to 6 weeks). The excess risk of postoperative pulmonary embolism ranged from odds ratio (OR), 5.24 (95% CI, 3.91-7.01) for vascular surgery to OR, 8.34 (95% CI, 6.07-11.45) for surgery for fractures. The risk remained elevated from 7 to 12 weeks, with the OR ranging from 2.26 (95% CI, 1.81-2.82) for gastrointestinal operations to 4.23 (95% CI, 3.01-5.92) for surgery for fractures. The risk was not clinically significant beyond 18 weeks postsurgery for all types of procedures. Conclusions and Relevance The risk of postoperative pulmonary embolism is elevated beyond 6 weeks postsurgery regardless of the type of procedure. The persistence of this excess risk suggests that further randomized clinical trials are required to evaluate whether the duration of postoperative prophylactic anticoagulation should be extended and to define the optimal duration of treatment with regard to both the thrombotic and bleeding risks.

中文翻译：

---

无癌的中年患者手术后6周以上发生肺栓塞的风险。

重要性据报道术后肺栓塞的风险在手术后的前5周内最高。然而，术后肺栓塞的额外风险持续多长时间仍是未知的。目的通过手术类型评估无癌中年患者晚期肺栓塞术后风险的持续时间和严重程度。设计，设置和参与者病例交叉分析，使用法国国家住院数据库的数据，计算6种类型的手术后发生肺栓塞的相应风险，该数据库覆盖了2007年至2007年之间8年间总计2.03亿住院患者2014年。受试者为无癌症的中年成年患者（45至64岁），诊断为首次发生肺栓塞。接触医院入院手术。手术程序分为6种类型：（1）血管外科手术；（2）妇科手术；（3）胃肠外科手术；（4）髋关节或膝关节置换术；（5）骨折；以及（6）其他骨科手术。主要结果和措施首次肺栓塞的诊断。结果共纳入60 703例患者（男性35 766 [58.9％]；平均[SD]年龄为56.6 [6.0]岁）。在所有类型的手术后，至少有12周的时间会增加术后肺栓塞的风险，并且在术后即刻（1至6周）内发生肺动脉栓塞的风险最高。术后肺栓塞的额外风险范围从血管外科手术的比值比（OR）为5.24（95％CI，3.91-7.01）到骨折手术的OR为8.34（95％CI，6.07-11.45）。风险从7周提高到12周，OR范围为2.26（95％CI，1.81-2。消化道手术的手术费用为82）（4.23（95％CI，3.01-5.92）。对于所有类型的手术，术后18周后该风险在临床上均不显着。结论和相关性，无论手术类型如何，术后术后6周以上的肺栓塞风险均会升高。这种过度风险的持续性表明，需要进一步的随机临床试验来评估是否应延长术后预防性抗凝治疗的持续时间，并就血栓和出血风险确定最佳的治疗持续时间。结论和相关性，无论手术类型如何，术后术后6周以上的肺栓塞风险均升高。这种过度风险的持续性表明，需要进一步的随机临床试验来评估是否应延长术后预防性抗凝治疗的持续时间，并就血栓和出血风险确定最佳的治疗持续时间。结论和相关性，无论手术类型如何，术后术后6周以上的肺栓塞风险均会升高。这种过度风险的持续性表明，需要进一步的随机临床试验来评估是否应延长术后预防性抗凝治疗的持续时间，并就血栓和出血风险确定最佳的治疗持续时间。