The venous thromboembolic complications of shoulder and elbow surgery

Abstract

We investigated the incidence of and risk factors for venous thromboembolism (VTE) following surgery of the shoulder and elbow and assessed the role of thromboprophylaxis in upper limb surgery. All papers describing VTE after shoulder and elbow surgery published in the English language literature before 31 March 2012 were reviewed. A total of 14 papers were available for analysis, most of which were retrospective studies and case series. The incidence of VTE was 0.038% from 92 440 shoulder arthroscopic procedures, 0.52% from 42 261 shoulder replacements, and 0.64% from 4833 procedures for fractures of the proximal humerus (open reduction and internal fixation or hemiarthroplasty). The incidence following replacement of the elbow was 0.26% from 2701 procedures. Diabetes mellitus, rheumatoid arthritis and ischaemic heart disease were identified as the major risk factors.The evidence that exists on thromboprophylaxis is based on level III and IV studies, and we therefore cannot make any recommendations on prophylaxis based on the current evidence. It seems reasonable to adopt a multimodal approach that involves all patients receiving mechanical prophylaxis, with chemical prophylaxis reserved for those who are at high risk for VTE.

The Incidence of Venous Thromboembolism Following Shoulder Surgery: A Pilot Study

“…8) However, there is a large amount of variability in the incidence of VTE following shoulder surgery reported in the literature, which ranged widely from <0.01% to 13%. [3][4][5][6][7][8][9][10][11] The lowest value represents VTE events with significant symptoms that required readmission for management, which have been typically reported in the retrospective studies. The highest value represents VTE events, including asymptomatic DVTs confirmed by Doppler ultrasonographic screening of all subjects in a prospective cohort study.…”

“…They described that the VTE events after fracture surgery were more common than elective shoulder surgeries. According to a systematic review by Dattani et al, 3) a total of 14 papers were available for analysis, most of which were retrospective studies and case series. They described that the incidence of VTE was 0.038% from 92,440 shoulder arthroscopic procedures, 0.52% from 42,261 shoulder replacements, and 0.64% from 4,833 procedures for proximal humerus fracture.…”

“…[3][4][5][6][7][8][9][10][11] According to a systematic review by Ojike et al, 8) the incidence of DVT after shoulder surgery was 0.24% and the incidence of PE was 0.11% with an overall incidence of VTE as 0.35%. Conversely, a recent prospective study by Willis et al 11) demonstrated that the incidence of DVT, confirmed by the Doppler ultrasonography, after shoulder arthroplasty was 13%, which was comparable to that after hip arthroplasty.…”

Incidence of symptomatic venous thrombo-embolism following shoulder surgery

“…Authors advocate that any research based on coding of diagnoses alone need to be made with care as there may be some underreporting of the incidence of VTE. In recent large systematic review of literature, Dattani et al [10] report an incidence of VTE after shoulder arthroscopy at a level of 0.038 % and after shoulder arthroplasty at a level of 0.52 %. The authors admitted though that the literature they reviewed was not always of good quality, with lack of technique used to diagnose VTE and no localization of DVT in many papers.…”

“…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 …”