Venous thromboembolism after elective shoulder surgery: a prospective cohort study of 175 patients

Takahashi, Hiroyuki; Yamamoto, Nobuyuki; Nagamoto, Hideaki; Sano, Hirotaka; Tanaka, Minoru; Itoi, Eiji

doi:10.1016/j.jse.2014.01.054

Cited by 34 publications

(50 citation statements)

References 30 publications

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“…All DVTs that were identified were asymptomatic, and all were identified within 2 days of surgery. One pulmonary embolus was found in 175 patients, which was also asymptomatic [44]. Keremsky et al found a 0.31 % incidence of symptomatic VTE in 1908 patients that had undergone arthroscopic surgery.…”

Section: Venous Thromboembolismmentioning

confidence: 99%

Management of complications after rotator cuff surgery

Parada

Dilisio

Kennedy

2014

Curr Rev Musculoskelet Med

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Rotator cuff repair (RCR) is a common procedure performed by orthopedic surgeons via arthroscopic, open, or mini-open techniques. While this surgery is considered to be of low morbidity, several potential complications can arise either intraoperatively or during the postoperative time period. Some of these complications are related to the surgical approach (arthroscopic or open), while others are patient dependent. Many of these complications can be managed through nonoperative means; however, early recognition and timely treatment is essential in limiting the long-term sequela and improving patient outcome. There are several different ways to classify complications after RCR repair: timing, severity, preventability, whether or not the pathology is intra-or extraarticular, and the type of treatment necessary. It is essential that the surgeon is cognizant of the etiology contributing to the failed RCR surgery in order to provide timely and proper management.

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Section: Venous Thromboembolismmentioning

confidence: 99%

Management of complications after rotator cuff surgery

Parada

Dilisio

Kennedy

2014

Curr Rev Musculoskelet Med

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“…43 Aggressive prophylaxis for thromboembolism can be provided in the two-week period after RTSA with special attention to asymptomatic DVT that can occur in the lower extremities. 44…”

Section: Discussionmentioning

confidence: 99%

“…43 Aggressive prophylaxis for thromboembolism can be provided in the two-week period after RTSA with special attention to asymptomatic DVT that can occur in the lower extremities. 44 Factors associated with RTSA Using the Norwegian Arthroplasty Register, Fevang et al 5 analyzed 69 reverse TSAs and found that risk of revision was lower in women (OR: 0.26) and that the most common cause for RTSA was aseptic loosening. Using the Mayo Clinic Joint Registry, Singh et al 45 analyzed 212 RTSAs and found that male gender (OR: 1.72) and rotator cuff disease (OR: 4.71) were associated with greater risk for RTSA (p < 0.05).…”

Section: Risk Stratification and Timing Of Adverse Events (Tables 4 Tmentioning

confidence: 99%

Risk factors for and timing of adverse events after revision total shoulder arthroplasty

et al. 2018

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Background Despite increasing rates of revision total shoulder arthroplasty (RTSA), there is a paucity of literature on optimizing perioperative outcomes. The purposes of this study were to identify risk factors for unplanned readmission and perioperative complications following RTSA, risk-stratify patients based on these risk factors, and assess timing of complications. Methods Bivariate and multivariate analyses of risk factors were assessed on RTSA patients from the ACS-NSQIP database from 2011 to 2015. Patients were risk-stratified and timing of severe adverse events and cause of readmission were evaluated. Results Of 809 RTSA patients, 61 suffered a perioperative complication or readmission within 30 days of discharge. Multivariate analysis identified operative time, BMI > 40, infection etiology, high white blood cell count, and low hematocrit as significant independent risk factors for 30-day complications or readmission after RTSA (p ≤ 0.05). Having at least one significant risk factor was associated with 2.71 times risk of complication or readmission within 15 days compared to having no risk factors (p < 0.001). The majority of unplanned readmission, return to the operating room, open/deep wound infection, and sepsis/septic shock occurred within two weeks of RTSA. Discussion Patients at high risk of complications and readmission after RTSA should be identified and optimized preoperatively to improve outcomes and lower costs.

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“…Previous studies gave inconsistent results. In a small prospective study, Takahashi et al 14 found an asymptomatic DVT rate of 5.7% in 175 patients who underwent a shoulder arthroscopy. Of note, all patients had an upper and lower limb vein ultrasonographic evaluation for DVT screening and used elastic stockings or foot pumps for VTE prophylaxis.…”

Section: For the Recos Investigatorsmentioning

confidence: 97%

Venous Thromboembolism in Patients Undergoing Shoulder Arthroscopy

Imberti

Dentali

Ivaldo

et al. 2015

Clin Appl Thromb Hemost

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for the RECOS InvestigatorsThe incidence of venous thromboembolism (VTE) after hip and knee major surgery without prophylaxis ranges from 29% to 60% for deep vein thrombosis (DVT) and from 1% to 3% for fatal pulmonary embolism (PE) 1-3 ; consequently, thromboprophylaxis in this clinical setting is strongly recommended by experts and international consensus guidelines. Conversely, limited information is available on the rate of VTE complications and thromboprophylaxis use in other orthopaedic surgeries, such as shoulder arthroscopy. 4 To the best of our knowledge, the incidence and risk factors for VTE in shoulder arthroscopy haven't been investigated in prospective epidemiological studies. Some independent, retrospective, observational studies and case series have reported a quite low VTE rate in shoulder arthroscopy [5][6][7][8][9][10][11][12] ; moreover, a few information is available on the safety and efficacy of thromboprophylaxis in this setting. Thus, current guidelines on the prevention of VTE in patients undergoing orthopedic surgery do not have a specific recommendation for those undergoing shoulder arthroscopy. In the recently published RECOS registry, we prospectively evaluated the incidence of symptomatic VTE following different types of shoulder surgery (arthroscopy, hemiarthroplasty, total replacement, and fixation for proximal humeral fracture.13 Furthermore, risk factors for VTE and thromboprophylactic practices in this population have also been analyzed.Here, we report the results of the RECOS registry in the specific group of patients undergoing shoulder arthroscopy. Study protocol and inclusion and exclusion criteria were already explained in a previous publication. 13 Briefly, from June 2009 to June 2011, 9 Italian centers participated in the registry and 1366 patients were enrolled. For each included patients, demographic characteristics, data regarding surgery, use of antithrombotic prophylaxis, potential VTE risk factors, and symptomatic objectively diagnosed VTE during 90 days follow-up were recorded. The decision to initiate thromboprophylaxis (as well as type, dose, and duration) was left to the investigators. Due to the low incidence (0.66%) of VTE in the whole population, only the following common potential VTE risk factors were evaluated for this study: gender, age, duration of surgery > 60 minutes, and body mass index (BMI) > 30 kg/m 2 . For the study purpose, the incidence of VTE after surgery in the whole population, and in the subgroups of patients in which antithrombotic prophylaxis was or was not prescribed, was assessed. Furthermore, results of subgroup analyses of patients with and without potential risk factors for VTE were presented to characterize subgroups at particular high or low risk of VTE. Incidences of VTE at the end of follow-up in the whole population and in specific subgroups were provided as percentages with the corresponding 95% confidence intervals (with continuity correction).Of the whole population, 982 (71.9%) patients underwent shoulder arthroscopy. The ...

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Venous thromboembolism after elective shoulder surgery: a prospective cohort study of 175 patients

Cited by 34 publications

References 30 publications

Management of complications after rotator cuff surgery

Management of complications after rotator cuff surgery

Risk factors for and timing of adverse events after revision total shoulder arthroplasty

Venous Thromboembolism in Patients Undergoing Shoulder Arthroscopy

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