Operative Duration as an Independent Risk Factor for Lower-Extremity Deep Vein Thrombosis Following Shoulder...

Venous thromboembolism (VTE) is a potentially deadly complication following orthopaedic surgery. However, its true incidence and risk factors after shoulder arthroscopy are not well understood, as most current evidence depends on symptom-based diagnosis, which may underestimate the actual incidence.

To determine the real-world incidence of VTE using systematic postoperative ultrasonographic screening and to identify independent risk factors.

Cohort study; Level of evidence, 2.

A total of 282 patients undergoing elective shoulder arthroscopy were prospectively enrolled. All patients had bilateral lower extremity venous color Doppler ultrasonography performed preoperatively and on postoperative day 1. Comprehensive demographic, clinical, and laboratory data were collected. Univariate and multivariate logistic regression analyses were conducted to identify independent predictors of postoperative deep vein thrombosis (DVT).

The incidence of postoperative DVT, diagnosed through systematic ultrasound screening, was 7.8% (22/282). After accounting for other factors, multivariate analysis found that longer operative duration is an independent risk factor. Specifically, each additional hour increases the odds by about 2.86 times (95% CI, 1.26-6.52; P = .01). No other clinical or laboratory variables, including preoperative coagulation and inflammatory markers, demonstrated a statistically significant association with postoperative DVT in the multivariate model.

This study reveals a substantially higher rate of VTE following shoulder arthroscopy than previously recognized. Operative duration is confirmed as a significant and identifiable independent risk factor. These findings highlight the need to reconsider VTE risk assessment in shoulder arthroscopy and support further research into risk-stratified prevention strategies.