Hernia Repair Turns Deadly

A 45-year-old male patient presented to an outpatient surgical center for laparoscopic repair of a hiatal hernia using Composix mesh. The procedure went without any complication and the patient was discharged the next day after receiving a prophylactic dose of anti-coagulation. The patient was discharged without any further medications and advised to ambulate as much as possible to prevent the formation of blood clots. The next day the patient reported to his primary care physician with complaints of chest pain and shortness of breath. He was rushed to the ER where he collapsed in the triage bay and was pronounced dead several minutes later by a suspected saddle pulmonary embolus.

Question(s) For Expert Witness

1. Should this patient have been discharged with more anti-coagulation medications and what could have been done to prevent the fatal events that ensued?

Expert Witness Response E-004465

DVTs and Pulmonary emboli are known complications after surgery but most patients are not placed on long term anticoagulation unless they are severely bed ridden or have multiple comorbid conditions that would necessitate further blood thinning. This was an unfortunate case but there is no way of picking up a saddle embolus unless the patient was being monitored closely.