Shoulder
Venous thromboembolic events are rare after shoulder surgery: analysis of a national database

https://doi.org/10.1016/j.jse.2010.11.034Get rights and content

Background

Data on venous thromboembolic (VTE) events after different types of shoulder surgery have not previously been available in large numbers in the United Kingdom. We aimed to determine baseline postoperative complication rates with reference to national thromboembolic prophylaxis guidelines.

Methods

Diagnostic and operative codes are routinely collected on every patient admitted to the hospital in the English NHS. Data for a 42-month period were analyzed for planned shoulder surgery (total replacement, hemiarthroplasty, or arthroscopy) and proximal humeral fracture surgery (internal fixation or replacement). In addition, complications during the two 6-month periods before and after the implementation of national thromboprophylaxis guidelines were compared. Rates of symptomatic deep venous thrombosis, pulmonary embolism, and mortality within 90 days were extracted.

Results

For total shoulder replacement (4,061 patients), deep venous thrombosis, pulmonary embolism, and mortality rates were 0%, 0.20%, and 0.22%, respectively. For arthroscopic procedures (65,302 patients), the rates were less than 0.01%, 0.01%, and 0.03%, respectively. For proximal humeral fracture surgery (internal fixation or replacement, 4,696 patients), the rates were 0.19%, 0.40%, and 3.02%, respectively. There was no significant difference in the VTE event or mortality rates before and after the introduction of the 2007 National Institute for Health and Clinical Excellence guidelines after arthroscopy or proximal humeral fracture surgery. A statistically significant decrease in total shoulder replacement–related mortality was found, from 0.72% (5 patients) to 0%.

Discussion

VTE disease is not a significant problem after shoulder surgery, and thromboprophylaxis may not be required, even in high-risk patients. National thromboprophylaxis guidelines did not affect VTE event rates.

Section snippets

Materials and methods

Data for adult patients (aged ≥18 years) who received either planned shoulder surgery (an arthroscopic procedure, total shoulder replacement [TSR], or hemiarthroplasty) or proximal humeral fracture surgery (open reduction–internal fixation [ORIF] or hemiarthroplasty) were collected from the Administrative Hospital Admissions Database (hospital episode statistics [HES]), augmented with more recent data from the Secondary Users Service (a system that reports and analyzes the latest data from NHS

Results

HES were available on a total of 80,227 shoulder procedures, of which 75,531 underwent treatment planning and 4,696 underwent treatment for proximal humeral fractures over the 42-month study period. Demographic data are shown in Table I. Ninety-day DVT rates ranged from 0% to 0.23% and PE rates from 0.01% to 0.52% (Table II). Mortality rates were low after planned surgery (0.03% to 0.47%). The rate of VTE events within 90 days of shoulder arthroscopy (0.01%) was comparable to background risk (

Discussion

Thromboprophylaxis after shoulder surgery is a contentious issue. There are no large-scale randomized trials published on rates of VTE events, and there is no good evidence for prophylaxis. Despite this, NICE continues to recommend thromboprophylaxis for “high-risk” shoulder surgery, extrapolating data from hip and knee replacement.15 On the basis of the 2010 NICE recommendations and data from this study, around half of shoulder arthroscopy patients, as well as the majority of TSR and

Conclusions

VTE events are extremely rare after shoulder surgery. Despite the introduction of national VTE prophylaxis guidelines recommending the use of chemical agents in shoulder surgery, rates of VTE events did not change. The national data presented here from the English NHS suggest that VTE disease is not a significant problem and thromboprophylaxis may not be required, even in high-risk patients.

Disclaimer

No additional funding or grants were received for this study.

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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    Ethical approval was not required for this study.

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