Incidence and Risk Factors for Venous Thromboembolic Events After Open Shoulder Surgery

Abstract

Background Although venous thromboembolic (VTE) events are known to develop after lower extremity surgery, there is little research on the risk of VTE after upper extremity surgery. The aim of this study is to identify the risk factors for VTE in patients undergoing open shoulder surgery. Methods We used International Classification of Diseases, 9th Revision, Clinical Modification procedure codes to identify patients in the Nationwide Inpatient Sample (NIS) from 1998 to 2011 who underwent open shoulder surgery. Patients were tracked to determine the incidence of VTE after surgery and stratified by demographics, comorbidities, and hospital characteristics. Risk factors were analyzed using multivariate analysis. Results A total of 315 423 open shoulder procedures were identified in the NIS from 1998 to 2011, of which 1420 (0.45%) carried a diagnosis of VTE, with 873 (0.27%) cases of pulmonary embolism, and 976 (0.31%) cases of deep vein thrombosis. The VTE incidence was similar in common shoulder surgeries, including total shoulder replacement (0.28%), partial shoulder replacement (0.51%), open reduction internal fixation of humerus (0.73%), and open rotator cuff repair (0.28%). Patients with VTE were older, male, African-American, and had a longer hospital stay (14.0 days compared with 3.2 days for patients without VTE). Comorbidities associated with higher risk of VTE included hypercoagulability (odds ratio [OR]: 5.62, P < .001), cancer (OR: 2.51, P < .001), congestive heart failure (OR: 2.01, P < .001), electrolyte abnormalities (OR: 2.1, P < .001), and obesity (OR: 1.46, P < .001). Conclusions There is a low overall risk of VTE after open shoulder surgery. Risk factors for VTE in this population should be used in conjunction with current guidelines to update recommendations for postoperative prophylactic treatment.