Venous Thromboembolism After Total Shoulder Arthroplasty: A Database Study of 31,918 Cases

Abstract

Introduction: Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a rare but serious complication of total shoulder arthroplasty (TSA). Owing to limited evidence, Clinical Practice Guideline recommendations for VTE chemoprophylaxis after TSA rely heavily on the risk stratification of individual patients. The objectives of this study were to identify the prevalence and risk factors independently associated with VTE, PE, and DVT in the 30-day postoperative period after TSA. Methods: A retrospective case-control study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database by querying the Current Procedural Terminology code for total shoulder arthroplasty from 2011 to 2020. The initial query resulted in 33,089 patients. After applying exclusion criteria for age younger than 50 years, emergency surgery, and open wound or infection, a final cohort of 31,918 patients who underwent TSA were included. The primary outcome was venous thromboembolism, and secondary outcome variables were PE and DVT. A bivariate screen was done for explanatory variables associated with our outcome variables, and variables with P , 0.1 in the bivariate screen were included in a multivariable logistic regression model. Results: Of the 31,918 patients in our cohort, 183 patients (0.573%) developed VTE, 92 patients (0.29%) developed PE, and 104 patients (0.326%) developed DVT during the 30-day postoperative period. Multivariable logistic regression analysis showed that older age, higher body mass index, longer surgical time, and longer hospital length of stay were associated with VTE and PE and that hypertension and shorter hospital length of stay were associated with DVT. Discussion: The prevalence of VTE after TSA is low. Older patients, patients with higher body mass index, and patients with longer surgical durations are at higher risk for VTE after TSA. Our findings are relevant for preoperative risk stratification and the decision for chemoprophylaxis.

Venous thromboembolism following surgical management of proximal humerus fractures: a systematic review

“… 15 Similarly, a higher body mass index, older age, and longer operative duration have also been shown to be independent risk factors for 30-day postoperative VTE. 34 In the field of shoulder arthroscopy, Triplet et al 30 conducted a systematic review of 13 studies with 32,407 patients undergoing shoulder arthroscopy and found an overall VTE rate of 0.21%, with those specifically undergoing arthroscopic rotator cuff repair (RCR) found to have a higher rate of 1.04% for VTE. Risk factors for VTE within 30 days of arthroscopic RCR have been shown to include a surgery longer than 80 minutes, use of general anesthesia, and an American Society of Anesthesiologists (ASA) class of 3 or 4.…”