Document Detail


Risk of thromboembolism in shoulder arthroplasty: effect of implant type and traumatic indication.
MedLine Citation:
PMID:  23392993     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Prior research about symptomatic venous thromboembolism (VTE) after shoulder arthroplasty has not determined whether procedure type (hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty) or surgical indication (traumatic or elective) represent risk factors for VTE after shoulder replacement.
QUESTIONS/PURPOSES: We therefore asked whether the risk of symptomatic VTE events and mortality within 90 days of shoulder arthroplasty was influenced by (1) procedure type, and (2) surgical indication (traumatic or elective).
METHODS: We performed a retrospective database review of symptomatic VTE events and mortality within 90 days of shoulder arthroplasty in a large (30-hospital) integrated healthcare system over a 5-year period, from January 2005 to December 2009. We compared the likelihood of VTE and death in patients undergoing reverse shoulder arthroplasties (RSAs), total shoulder arthroplasties (TSAs), and hemiarthroplasties (HAs), and we compared the likelihood of VTE and death in patients who underwent elective shoulder arthroplasties with those who underwent shoulder arthroplasty in the setting of acute trauma.
RESULTS: In the 2574 eligible shoulder arthroplasties identified during the study period, VTE developed in 1.01% of patients (deep vein thrombosis 0.51% and pulmonary embolism 0.54%). With the numbers available, no differences were observed in rates of VTE or mortality by procedure type. A trend toward increased VTE occurred more frequently in patients having surgery for traumatic indications than after elective surgery (1.71% versus 0.80%; p = 0.055). A higher likelihood of 90-day mortality was observed in trauma patients compared with elective (odds ratio = 7.4; 95% CI, 2.4-25.2).
CONCLUSIONS: VTE occurred infrequently in this study sample. These data support future risk and benefit assessment of routine pharmacologic VTE prophylaxis in the perioperative treatment of patients undergoing shoulder arthroplasty, especially in all RSA and traumatic HA subsets, where the risk of VTE may be higher.
Authors:
Ronald A Navarro; Maria C S Inacio; Mary F Burke; John G Costouros; Edward H Yian
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study     Date:  2013-02-08
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-02     Completed Date:  2013-05-22     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1576-81     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Arthroplasty, Replacement / adverse effects*,  instrumentation*,  mortality
California / epidemiology
Chi-Square Distribution
Emergencies
Female
Humans
Incidence
Joint Prosthesis*
Logistic Models
Male
Middle Aged
Odds Ratio
Prosthesis Design
Pulmonary Embolism / diagnosis,  epidemiology*,  mortality
Retrospective Studies
Risk Assessment
Risk Factors
Shoulder Joint / injuries,  surgery*
Surgical Procedures, Elective
Time Factors
Treatment Outcome
Venous Thromboembolism / diagnosis,  epidemiology*,  mortality
Venous Thrombosis / diagnosis,  epidemiology*,  mortality
Comments/Corrections
Comment In:
Clin Orthop Relat Res. 2013 May;471(5):1582-3   [PMID:  23456192 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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