Incidence of symptomatic venous thrombo-embolism following shoulder surgery

Abstract

Purpose This clinical study was performed to establish the incidence of symptomatic deep vein thrombosis and pulmonary embolism after shoulder surgery as the incidence of venous thrombo-embolism complicating shoulder surgery is poorly described in literature. Methods We reviewed retrospectively clinical records of 920 consecutive patients who had any surgical procedure performed on their shoulder in Glan Clwyd Hospital, North Wales and a further 1,421 consecutive patients who had surgery in Morriston and Singleton Hospitals, South Wales. Patients' records were assessed for any admissions due to proven VTE; we investigated for any radiological results suggestive of venous thrombo-embolism and for deaths in the post-operative period. Results We analyzed data of 2,341 patients. There was one fatal PE in this group, whereby the patient died within 48 hours following reverse shoulder replacement, and post mortem revealed massive pulmonary embolism. There were a further three cases of symptomatic, non-fatal PE. There were six cases of symptomatic DVT of lower limb. All these cases were treated successfully with anticoagulation. No upper limb DVT was identified. Conclusion Recent studies suggest that DVT prevalence following shoulder arthroplasty is as high as 13 %. In our study we examined occurrence of symptomatic VTE only. According to our results the prevalence of symptomatic DVT following shoulder surgery is 0.26 %, symptomatic PE 0.17 % and combined prevalence of VTE is 0.43 %. We would advise careful thought about the risk of thrombosis and use mechanical prophylaxis in shoulder surgery, especially for longer procedures. We would not recommend routine pharmacological prophylaxis unless there are additional risk factors.

Asymptomatic Pulmonary Embolism After Shoulder Arthroscopy: Case Report and Literature Review

“…The incidence of PE after shoulder arthroscopy has been reported to be 0.01%–0.13% 1,7,10–15 . A study by Jameson et al 11 ,.…”

“…Given the fact that mechanical prophylaxis does not necessarily contribute to a lower incidence of VTE, many researchers still think routine chemoprophylaxis for perioperative VTE in shoulder arthroscopy patients is unnecessary, in view of its low incidence and the potential adverse drug reactions of anticoagulants. The majority of researchers recommend an implementaiton of chemoprophylaxis in patients at a high risk of VTE, particularly when multiple risk factors coexist 2,15,17,29 . Chemoprophylaxis should be based on the substantial estimation of individual risk of bleeding.…”

Recommendations from the ICM-VTE: Shoulder & Elbow

“…Available literature reports wide variability in the incidence of VTE events following shoulder arthroplasty, with estimates ranging from 0.2%-16% 101-116 . However, these studies varied significantly in how VTE events were identified.…”

Is venous thromboembolism prophylaxis beneficial in upper limb major joint replacement surgery? A systematic review

“…Two articles did not provide baseline characteristics to assess the number of each surgical procedure performed. 27,35 These surgical procedures were performed for a range of indications, of which 73% were due to osteoarthritis, with the remaining procedures due to proximal humeral fractures, inflammatory arthropathy, rotator cuff arthropathy, osteonecrosis and failed primary operations (Table 2). The mean age of patients was 66.5 years.…”

“…Mortality secondary to VTE was reported in four articles, each reporting a single case from a total of 634 patients. 16,18,22,27 Other complications including post-thrombotic syndrome and clot extension triggering cardiac involvement were not reported.…”