ArticleBMJ open2026
Knowledge and attitudes towards perioperative pulmonary embolism in major orthopaedic surgery patients: a cross-sectional study in Shanghai.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study investigated the knowledge and attitudes (KA) towards perioperative pulmonary embolism (PE) in patients undergoing major orthopaedic surgery, a population at particular risk.
designA single-centre, cross-sectional study.
settingA tertiary care hospital in Shanghai, China.
participants454 patients scheduled for major orthopaedic surgery (Grade III or above) were enrolled between February and September 2024. Selection criteria included adult patients undergoing eligible procedures, while exclusion criteria encompassed cognitive impairment or refusal to participate. All enrolled participants completed the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were the total scores on validated knowledge and attitude questionnaires. Secondary outcomes included the identification of demographic factors associated with these scores and the analysis of the direct relationship between knowledge and attitude using structural equation modelling (SEM).
resultsThe average knowledge score was 52.9% (23.82/45), indicating poor understanding. The average attitude score was 66.4% (29.88/45), indicating a moderate attitude. The multivariable analysis showed that a college diploma (OR=4.824, 95% CI 2.399 to 9.703, p<0.001) and a bachelor's degree or above (OR=19.754, 95% CI 6.906 to 56.503, p<0.001) were independently associated with both adequate knowledge and a positive attitude. Higher knowledge scores were also directly associated with a positive attitude (OR=1.041, 95% CI 1.004 to 1.079, p=0.028). However, SEM analysis revealed that greater knowledge had a paradoxical negative direct impact on attitude (β=-0.484, 95% CI -0.565 to -0.402, p<0.001).
conclusionPatients undergoing major orthopaedic surgery possess poor knowledge but moderately positive attitudes toward PE. Educational level is a key factor influencing KA. Improving patient knowledge and attitudes is crucial for supporting informed surgical decision-making and enhancing perioperative self-management, though the complex relationship between knowledge and attitude warrants further investigation.
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