Pulmonary embolism in shoulder arthroplasty: a National Joint Registry Study

In the UK, there is no specific guidance on prophylaxis for venous thromboembolism (VTE) following shoulder arthroplasty (SA). This study reviews the current incidence of pulmonary embolism (PE) and prophylaxis practices following SA in England.

Data were obtained from the National Joint Registry (NJR) for all SAs from 1 April 2012 to 31 March 2022 and linked with Hospital Episode Statistics (HES). ICD-10 codes identified incidence of PE at 30 and 90 days from arthroplasty. Incidence for PE was calculated by cohort and implant type at 30 and 90 days postoperatively. Multivariable logistic regression identified factors associated independently with PE.

A total of 47,145 procedures were included in the NJR HES linked database; 26,403 reverse SAs (RSAs), 12,736 total SAs (TSAs) and 8,006 hemiarthroplasties (HAs). The cumulative incidence of PE was 0.25% at 30 days and 0.33% at 90 days. By implant type, the cumulative incidence was 0.32% following RSA, 0.15% following TSA and 0.18% following HA at 30 days, and 0.41%, 0.21% and 0.25%, respectively, at 90 days. Chemical VTE prophylaxis was received following 74.55% of procedures and mechanical prophylaxis following 96.27%. Most common chemical prophylaxis was low molecular weight heparin (91.34%). Congestive cardiac failure, peripheral vascular disease, metastatic disease and trauma indication were associated independently with PE.

Although uncommon, PE remains an important postoperative complication given its associated morbidity and mortality. Despite most patients receiving some form of prophylaxis no agreed guidance exists in SA and further studies are needed to inform such guidance.