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