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Clin Orthop Relat Res. 2013 May;471(5):1576-81. doi: 10.1007/s11999-013-2829-6. Epub 2013 Feb 8.

Risk of thromboembolism in shoulder arthroplasty: effect of implant type and traumatic indication.

Author information

1
Department of Orthopaedic Surgery, Kaiser Permanente, South Bay, 25821 S Vermont Avenue, Harbor City, CA 90710, USA. Ronald.A.Navarro@kp.org

Abstract

BACKGROUND:

Prior research about symptomatic venous thromboembolism (VTE) after shoulder arthroplasty has not determined whether procedure type (hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty) or surgical indication (traumatic or elective) represent risk factors for VTE after shoulder replacement.

QUESTIONS/PURPOSES:

We therefore asked whether the risk of symptomatic VTE events and mortality within 90 days of shoulder arthroplasty was influenced by (1) procedure type, and (2) surgical indication (traumatic or elective).

METHODS:

We performed a retrospective database review of symptomatic VTE events and mortality within 90 days of shoulder arthroplasty in a large (30-hospital) integrated healthcare system over a 5-year period, from January 2005 to December 2009. We compared the likelihood of VTE and death in patients undergoing reverse shoulder arthroplasties (RSAs), total shoulder arthroplasties (TSAs), and hemiarthroplasties (HAs), and we compared the likelihood of VTE and death in patients who underwent elective shoulder arthroplasties with those who underwent shoulder arthroplasty in the setting of acute trauma.

RESULTS:

In the 2574 eligible shoulder arthroplasties identified during the study period, VTE developed in 1.01% of patients (deep vein thrombosis 0.51% and pulmonary embolism 0.54%). With the numbers available, no differences were observed in rates of VTE or mortality by procedure type. A trend toward increased VTE occurred more frequently in patients having surgery for traumatic indications than after elective surgery (1.71% versus 0.80%; p = 0.055). A higher likelihood of 90-day mortality was observed in trauma patients compared with elective (odds ratio = 7.4; 95% CI, 2.4-25.2).

CONCLUSIONS:

VTE occurred infrequently in this study sample. These data support future risk and benefit assessment of routine pharmacologic VTE prophylaxis in the perioperative treatment of patients undergoing shoulder arthroplasty, especially in all RSA and traumatic HA subsets, where the risk of VTE may be higher.

PMID:
23392993
PMCID:
PMC3613522
DOI:
10.1007/s11999-013-2829-6
[Indexed for MEDLINE]
Free PMC Article

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