Risk of Thromboembolism in Shoulder Arthroplasty: Effect of Implant Type and Traumatic Indication

Navarro, Ronald A.; Inacio, Maria C.S.; Burke, Mary F.; Costouros, John G.; Yian, Edward H.

doi:10.1007/s11999-013-2829-6

Cited by 37 publications

(32 citation statements)

References 12 publications

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“…A recent study by Navarro et al in 2574 patients undergoing shoulder arthroplasty conveys the prevalence of PE within 90 days of shoulder arthroplasty to be 0.54%. 18 Another study of 3,480 patients by Singh et al showed that 0.9–1.2% of shoulder arthroplasties resulted in PE within 90 days. 29 The higher rates presented by these two studies may show that many perioperative PE occur after the patient has been discharged.…”

Section: Discussionmentioning

confidence: 99%

“…5,17,36 In addition to shoulder arthroplasty being a less common procedure than lower extremity arthroplasty, the rates of PE are lower ranging from 0.2%–0.54. 18 Together this may account for less literature concerning PE associated with shoulder arthroplasty. To our knowledge, no study has investigated risk factors for PE using a large, nationally representative sample.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with in-hospital pulmonary embolism after shoulder arthroplasty

Young

Menendez

Baker

et al. 2015

Journal of Shoulder and Elbow Surgery

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Background Despite pulmonary embolism (PE) being a feared complication after shoulder arthroplasty, little is known about its perioperative associated factors. Materials and Methods We used the Nationwide Inpatient Sample to gather a sample of 422,372 patients who underwent shoulder arthroplasty between 2002 and 2011. This population was divided into two cohorts based on those who experienced perioperative PE (0.25%) and those who did not. Demographics were compiled for both cohorts. Multivariable logistic regression analysis was used to account for confounding variables and determine significant predictors of perioperative PE. Results After adjusting for patient demographic and clinical variables in multivariable regression modeling, the top 4 independent predictors for PE were primary diagnosis of proximal humerus fracture, deficiency anemia, congestive heart failure, and chronic lung disease. Other pertinent risk factors included increasing age, obesity, fluid and electrolyte abnormalities, undergoing TSA rather than HA, and subsequent days of post-operative care. Conclusions Knowledge of these factors might help in preoperative counseling and prove useful for implementation of quality improvement strategies to reduce its occurrence. Surgeons may consider initiating thromboprophylaxis in patients with any of the aforementioned comorbidities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors associated with in-hospital pulmonary embolism after shoulder arthroplasty

Young

Menendez

Baker

et al. 2015

Journal of Shoulder and Elbow Surgery

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“…Saleh et al [4] quote the incidence of VTE after shoulder arthroplasty in their systematic review to be at a rate from 2 % to 16 %. Navarro et al [5] reported a VTE rate of 1 % in the cohort of 2,574 patient who had shoulder arthroplasty. Table 2 represents the reported incidence of VTE by other authors with methodology used.…”

Section: Discussionmentioning

confidence: 99%

“…Rate of ASYMPTOMATIC VTE Navarro et al [5] Shoulder arthroplasty 2,574 1.01 % Retrospective, based on clinical coding (US) Dattani et al [10] Shoulder …”

Section: Authors Acknowledge Several Limitations Of the Studymentioning

confidence: 99%

Incidence of symptomatic venous thrombo-embolism following shoulder surgery

Wronka

Pritchard

Sinha

2014

International Orthopaedics (SICOT)

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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.

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“…5) Jameson et al 2) reported higher VTE rates for traumatic arthroplasty than for elective arthroplasty, but without major clinical significance (all lower than 1%). Navarro et al 9) found no significant associations between procedure type (total shoulder arhtroplasty, reverse total shoulder arthroplasty, or hemiarthroplasty) or surgery indication (traumatic or elective) and the risks of pulmonary embolism, DVT, VTE, or 90-day mortality. In our case, the patient did not have any risk factor, and we could not found any DVT.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism after Screw Fixation for a Greater Tubercle Fracture of Humerus

Kang¹,

Chung²,

Kim³

et al. 2014

Clinics in Shoulder and Elbow

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Pulmonary embolism is a serious complication, which is well known in patients undergoing total hip or total knee arthroplasty or lower extremity fracture surgery. But, there are few literatures concerning pulmonary embolism after upper extremity surgery. Pulmonary embolism after minor upper extremity fracture surgery is extremely rare. We report a case of 66-year-old female patient that developed pulmonary embolism after percutaneous cannulated screw fixation for a greater tubercle fracture of the proximal humerus with literature review. Deep vein thrombosis (DVT) and pulmonary embolism is a commonly recognized complication after lower extremity arthoplasty. It is rare after upper extremity surgery. The majority of reported cases of pulmonary embolism after upper extremity surgery have occurred in patients after shoulder arthroplasty, [1][2][3][4] shoulder arthroscopic surgery, 2,5-7) but their incidence rates are very low. Rarely, single cases of pulmonary embolism after open glenohumeral joint debridement, subacromial decompression of the shoulder, and surgical treatment of ulnar pseudoarthrosis have been reported. Pulmonary embolism after surgery for a proximal humerus fracture has been also reported, but these procedures involved hemiarthroplasty or open reduction-internal fixation. 1,2) Pulmonary embolism after minor upper extremity fracture surgery is extremely rare. We experienced a case of a 66-year-old female patient that developed pulmonary embolism after percutaneous cannulated screw fixation for a greater tubercle fracture of the right proximal humerus. However, little information is available in the literature concerning pulmonary embolism after upper extremity surgery. 2,4,8) Here, we report a case of pulmonary embolism after percutaneous cannulated screw fixation for a greater tubercle fracture of the proximal humerus with literature review. Case ReportA case of 66-year-old female without any explicit risk factor presented at our out-patient department after slip down during which her right shoulder struck the ground complaining of pain in right shoulder joint. She did not have any history of medical disease or a family history of DVT or pulmonary embolism. Her surgical history included kyphoplasty for an osteoporotic compression fracture of the T12 spine with an uneventful outcome 3 years previously. Physical examination showed no external wound but severe tenderness over the greater tubercle of right proximal humerus. She was unable to elevate the right arm actively to an overhead position, but motor, sensory and vascular examinations of upper extremity were normal. Right shoulder radiographs revealed no definite fracture line but coronal magnetic resonance imaging revealed a diffuse high signal change in the greater tubercle of the right proximal humerus on T2W image and a lower signal change on T1W image, suggesting non-displaced fracture of the greater tubercle of the proximal humerus. The arm was protected with c-type sling.One week later, the right shoulder pain had not resolved and a follo...

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Risk of Thromboembolism in Shoulder Arthroplasty: Effect of Implant Type and Traumatic Indication

Cited by 37 publications

References 12 publications

Factors associated with in-hospital pulmonary embolism after shoulder arthroplasty

Factors associated with in-hospital pulmonary embolism after shoulder arthroplasty

Incidence of symptomatic venous thrombo-embolism following shoulder surgery

Pulmonary Embolism after Screw Fixation for a Greater Tubercle Fracture of Humerus

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