OBJECTIVES: Orthopaedic surgery is one of the highest risk factors for venous thromboembolism. The main objective of this retrospective database analysis was to examine direct medical costs for pulmonary embolism (PE) in patient undergoing orthopaedic surgery in Slovakia from the payer perspective.  METHODS: A retrospective database analysis of biggest health insurance company in Slovakia was conducted. Resources used and their respective costs in connection with PE were collected for patients undergoing elective total hip replacement (THR) or elective total knee replacement (TKR) during the period from 1.1. 2008 till 1.1.2009. All resources and costs were categorized in 4 groups: inpatient, outpatient, drugs and examinations. Costs in Euro were calculated with official exchange rate 30,126 Sk/€. Cost comparison between groups of patients with PE and without PE after orthopaedic surgery was done.  RESULTS: The group of 3 008 patients (995 men and 2 013 women) after elective orthopaedic surgery was analyzed. There were 2 325 patients with THR and 993 with TKR. 12 cases of PE which were hospitalized, were identified in the whole group . Average direct medical costs for group of patients hospitalized for pulmonary embolism were €3 909 with the following structure of costs: inpatient – €2 442; outpatient -  €168;  drugs - €552; examinations  -€747 respectively.  CONCLUSIONS: Average direct medical costs for patients with PE after elective orthopedic surgery were €3 909 in 2008. This is €724 more then the average direct medical costs for patients without PE.