Venous thromboembolism in patients undergoing shoulder surgery: Findings from the RECOS Registry

Imberti, Davide; Ivaldo, Nicola; Murena, Luigi; Paladini, Paolo; Castagna, Alessandro; Barillari, Giovanni; Guerra, Enrico; Fama, G; Castoldi, Filippo; Marelli, B; Giorgi‐Pierfranceschi, Matteo; Camporese, Giuseppe; Dentali, Francesco; Porcellini, Giuseppe

doi:10.1016/j.thromres.2014.05.014

Cited by 29 publications

(33 citation statements)

References 17 publications

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“…For example, inpatient status, sex, anesthesia type, obesity, smoking, malignancy, operative time, CHF, COPD, anemia, and independent functional status were not associated with VTE occurrence as loosely suggested in previous literature 12, 14, 15, 33, 36, 38. However, even in recent studies, these risk factors and pre-existing conditions have not been replicated, with statistical significance often not having been met 21, 40. Many suggested mechanisms of VTE in TSA relate to procedural technique, including axillary vein damage during humeral manipulation, direct pressure from retractors, embolic showering through intramedullary reaming, lower-extremity venous stasis from beach-chair positioning, increased dissection, and prolonged operative time 4, 25, 32, 37, 42.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, modifiable factors such as mobility, smoking, prolonged operative time, patient positioning, intramedullary instrumentation, and alcohol use have been implicated in the increased risk of VTE in TSA patients 12, 14, 33, 42. However, these preoperative factors are not consistently associated with an increased risk of VTE in the literature, as numerous studies have failed to show notable associations between VTE and malignancy, increasing age, prior VTE, reduced mobility, blood disorders, and obesity 14, 21, 38, 40. Past guidelines from the National Institute for Health and Care Excellence regarding postoperative low-molecular-weight heparin have been revised because of a lack of established risk factors, and the 2010 American Academy of Orthopaedic Surgeons guidelines only recognized a history of VTE as a reliable risk factor 2, 5, 9, 22.…”

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confidence: 99%

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Risk factors for venous thromboembolism in total shoulder arthroplasty

et al. 2019

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BackgroundAlthough venous thromboembolism (VTE) has been studied in lower-extremity arthroplasty, there are few guidelines regarding established risk factors for VTE in total shoulder arthroplasty (TSA). With literature suggesting the VTE rate may be as high as 13%, VTE prevention and risk factors should be considered in preoperative planning.MethodsAll TSAs from 2011 through 2016 were queried from the National Surgical Quality Improvement Program database. Age, sex, body mass index, American Society of Anesthesiologists class, ethnicity, functional status, comorbidities, discharge destination, surgical indication, length of stay, and operative time were compared between patients with and without 30-day postoperative VTE. Pearson χ2 and t tests were used to assess baseline categorical and continuous variables, respectively. Multivariate logistic regression analysis was conducted to determine associated independent risk factors for VTE.ResultsThe analysis included 13,299 patients; VTE developed in 83 patients (0.62%). Patients with VTE were older (72 years vs. 69 years) and had a longer hospital stay (3.5 days vs. 1.9 days). Compared with patients with no VTE, patients with VTE were more likely to undergo TSA for proximal humeral fractures, to be discharged to a rehabilitative center, to have a preoperative albumin level lower than 3.5 g/dL, to undergo non-elective surgery, to have an American Society of Anesthesiologists class of 3 or greater, to have a surgical-site infection develop, and ultimately to need a shoulder reoperation (all P < .05). Multivariate logistic regression analysis revealed that hypoalbuminemia (albumin level < 3.5 g/dL), an increased length of stay, and African American ethnicity were independent risk factors for VTE development.ConclusionPatients with hypoalbuminemia, an increased length of stay, and African American ethnicity are at an increased risk of VTE after shoulder arthroplasty. A high index of suspicion is warranted for elderly patients with fractures who may need preoperative medical optimization.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Risk factors for venous thromboembolism in total shoulder arthroplasty

et al. 2019

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“…The incidence of lower extremity DVT in these patients was 0.2 % and none of the 982 arthroscopic patients developed an upper extremity DVT. A symptomatic pulmonary embolism was identified in 0.1 % of these patients and there were no patient deaths [43]. Takashashi et al found a 5.7 % incidence of DVT in a cohort of 175 patients within 90 days after arthroscopic shoulder surgery.…”

Section: Venous Thromboembolismmentioning

confidence: 96%

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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“…Contrary to previous data [101], recent data, including results from the RECOS registry (102), is reporting very low (less than 1%) postshoulder replacement VTE [103,104]. Systematic VTE prophylaxis is therefore not recommended after shoulder replacement and should be reserved for selected cases only.…”

Section: Post-shoulder Replacement Uedvtmentioning

confidence: 83%

Upper Extremity Deep Venous Thrombosis (UEDVT)

Badr¹

2015

Intern Med

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Upper extremity Deep Venous Thrombosis (UEDVT) is frequent in the hospital, especially in the intensive care unit. It often complicates the placement of central venous catheters (CVC), notably peripherally inserted central (PICC) lines. Despite a lower rate of pulmonary embolism, UEDVT is as fatal as lower extremity DVT. This is due to its strong association with cancer. Symptoms are often absent, but systematic screening is not recommended. The best prophylaxis is good central catheter management. Pharmacological prophylaxis has questionable effectiveness in the prophylaxis of CVC-associated UEDVT. Compression ultrasonography is the first line diagnostic tool. Treatment is anticoagulation for at least 3 months. A causative central line should be removed as soon as clinically possible. Infrequently, patients with the thoracic outlet syndrome can get an effort related primary UEDVT. It is also known as the Paget-Schroetter syndrome. Along with anticoagulation, surgical referral for decompression of the thoracic outlet is then necessary. The current state of evidence on UEDVT is rather poor, due to the absence of large randomized controlled trials.

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Venous thromboembolism in patients undergoing shoulder surgery: Findings from the RECOS Registry

Cited by 29 publications

References 17 publications

Risk factors for venous thromboembolism in total shoulder arthroplasty

Risk factors for venous thromboembolism in total shoulder arthroplasty

Management of complications after rotator cuff surgery

Upper Extremity Deep Venous Thrombosis (UEDVT)

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