This case involves a female patient in Michigan who was diagnosed with cervical cancer. She underwent a hysterectomy, however the patient was not placed on any blood clot prophylaxis post-operatively. A few weeks after the procedure, the patient was noted to be short of breath, with her respiratory distress worsening over the next day. Imaging studies revealed acute pulmonary emboli, and she was started on heparin. Additional testing revealed a critically low hemoglobin. She was transferred to the ICU and administered blood products, however her respiratory status continued to decline. The patient eventually expired, and an autopsy revealed the cause of death to be an acute pulmonary thromboembolism.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case? Please explain.
- 2. Have you ever had a patient develop the outcome described in the case? If so, please explain.
- 3. How often do you perform the procedure described in the case summary? What are some of the common complications?
Expert Witness Response E-019122
In my practice, I routinely treat patients similar to the one described in this case. As part of my practice, I typically perform 4-5 simple hysterectomies a week and 2-3 radical hysterectomies (similar to the one performed in this case) per month. Thromboembolic events are a known complication of radical hysterectomies and I have had patients develop this complication but have not had patients progress to the point of death due to this complication. Other complications include hemorrhage, ureteral injury, bladder and bowel injury. Since this is a know complication of this procedure, some form of prophylaxis may have been warranted.