Prophylactic Aspirin Use Following Shoulder Surgery: A Retrospective Cohort Study

Background There is no clear consensus regarding the role of aspirin (acetylsalicylic acid, ASA) for venous thromboembolism (VTE) prophylaxis following shoulder arthroscopy or arthroplasty. Although rare, catastrophic complications have been reported surrounding the use of aspirin, or lack thereof, including deep vein thrombosis (DVT), hematoma, hospital readmission, and reoperation. Methodology We conducted a retrospective review of 1,272 patients who underwent shoulder arthroscopy or arthroplasty at a single institution between 2017 and 2023. Baseline demographic information, medical risk factors, chronic anticoagulation status, and the use of postoperative VTE/DVT prophylaxis were collected. Outcomes recorded within 90 days included VTE/DVT, symptomatic hematoma, readmission, and reoperation. Patients were stratified by procedure type and ASA use. Results Postoperatively, 70.8% of patients received ASA, which was not significantly associated with DVT (0.24% overall incidence, p = 0.9864), hematoma (p = 0.7254), reoperation (p = 0.2901), or readmission (p = 0.4326). Compared with arthroscopy, arthroplasty was associated with significantly higher rates of hematoma (2.46% vs. 0.19%, p < 0.0001), reoperation (4.43% vs. 1.03%, p = 0.0004), and readmission (5.91% vs. 0.37%, p < 0.0001). Chronic anticoagulation independently increased the risk of readmission (p = 0.0014) and reoperation (p = 0.0176), while advanced age was associated with higher rates of hematoma (p = 0.0027) and readmission (p = 0.0077). No significant associations were found between body mass index or diabetes and adverse outcomes. Conclusions The observed incidence of symptomatic VTE/DVT following shoulder arthroscopy and arthroplasty was low. Postoperative ASA use was not significantly associated with VTE/DVT or the evaluated postoperative complications. However, given the limited number of VTE/DVT events and nonrandomized treatment allocation, these findings do not establish equivalence between prophylaxis strategies or exclude a clinically meaningful benefit of ASA. Decisions regarding chemoprophylaxis should therefore be individualized according to patient and procedural risk factors.