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Venous Thromboembolism Prophylaxis in Shoulder Surgery.
William R Aibinder1, Joaquin Sanchez-Sotelo1
1Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
The Orthopedic Clinics of North America
|March 4, 2018
Summary
Estimating venous thromboembolic events (VTEs) after shoulder surgery is challenging due to inconsistent data. Current literature lacks evidence-based criteria for VTE prevention in shoulder surgery patients.
Area of Science:
- Orthopedic Surgery
- Vascular Medicine
- Patient Safety
Background:
- Venous thromboembolic events (VTEs), including deep vein thrombosis and pulmonary embolism, are potential complications following surgical procedures.
- The precise incidence and risk factors for VTEs specifically after shoulder surgery remain incompletely defined in the existing medical literature.
- Variability in study methodologies, including the distinction between symptomatic and asymptomatic events and anatomical location, contributes to a wide range of reported VTE rates.
Purpose of the Study:
- To critically evaluate the current literature regarding the incidence and management of venous thromboembolic events (VTEs) after shoulder surgery.
- To identify patient and surgical factors associated with an increased risk of VTEs following shoulder procedures.
- To assess the evidence supporting prophylactic measures for VTE prevention in the context of shoulder surgery.
Main Methods:
- A comprehensive review of existing literature, including case reports, retrospective studies, prospective studies, and systematic reviews, was conducted.
- Data were analyzed to determine the reported incidence rates of VTEs complicating shoulder surgery.
- Risk factors such as surgical approach (arthroplasty vs. arthroscopy) and indication (fracture repair) were examined for their association with VTE risk.
Main Results:
- Reported incidence rates of VTEs following shoulder surgery vary significantly, ranging from 0.02% to 13%.
- Shoulder arthroplasty and surgery for fracture are associated with a higher incidence of VTEs compared to arthroscopic procedures.
- Mechanical prophylaxis (e.g., compression devices) shows a favorable risk-benefit profile, while chemical prophylaxis may be considered for high-risk individuals.
Conclusions:
- The current body of evidence is insufficient to establish definitive, evidence-based criteria for VTE prophylaxis after shoulder surgery.
- Further high-quality research is needed to accurately quantify VTE risk and guide optimal prevention strategies.
- A tailored approach considering patient risk factors and surgical type is recommended in the interim.
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