title: Venous thromboembolic events are rare after shoulder surgery: analysis of a national database.
abstract: BACKGROUND
  Data on venous thromboembolic (VTE) events after different types of shoulder surgery have not previously been available in large numbers in the United Kingdom. We aimed to determine baseline postoperative complication rates with reference to national thromboembolic prophylaxis guidelines.
  
  
  METHODS
  Diagnostic and operative codes are routinely collected on every patient admitted to the hospital in the English NHS. Data for a 42-month period were analyzed for planned shoulder surgery (total replacement, hemiarthroplasty, or arthroscopy) and proximal humeral fracture surgery (internal fixation or replacement). In addition, complications during the two 6-month periods before and after the implementation of national thromboprophylaxis guidelines were compared. Rates of symptomatic deep venous thrombosis, pulmonary embolism, and mortality within 90 days were extracted.
  
  
  RESULTS
  For total shoulder replacement (4,061 patients), deep venous thrombosis, pulmonary embolism, and mortality rates were 0%, 0.20%, and 0.22%, respectively. For arthroscopic procedures (65,302 patients), the rates were less than 0.01%, 0.01%, and 0.03%, respectively. For proximal humeral fracture surgery (internal fixation or replacement, 4,696 patients), the rates were 0.19%, 0.40%, and 3.02%, respectively. There was no significant difference in the VTE event or mortality rates before and after the introduction of the 2007 National Institute for Health and Clinical Excellence guidelines after arthroscopy or proximal humeral fracture surgery. A statistically significant decrease in total shoulder replacement-related mortality was found, from 0.72% (5 patients) to 0%.
  
  
  CONCLUSIONS
  VTE disease is not a significant problem after shoulder surgery, and thromboprophylaxis may not be required, even in high-risk patients. National thromboprophylaxis guidelines did not affect VTE event rates.
authors.affiliation: James Cook University Hospital, Middlesbrough, UK. simonjameson@doctors.org.uk
authors.forename: Simon S
authors.initials: SS
authors.lastname: Jameson
authors.forename: Philip
authors.initials: P
authors.lastname: James
authors.forename: Daniel W J
authors.initials: DW
authors.lastname: Howcroft
authors.forename: Ignacio
authors.initials: I
authors.lastname: Serrano-Pedraza
authors.forename: Amar
authors.initials: A
authors.lastname: Rangan
authors.forename: Mike R
authors.initials: MR
authors.lastname: Reed
authors.forename: Jaime
authors.initials: J
authors.lastname: Candal-Couto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011159:Population Surveillance; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult