title: Risk of thromboembolism in shoulder arthroplasty: effect of implant type and traumatic indication.
abstract: 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.
  
  
  OBJECTIVE
  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: Department of Orthopaedic Surgery, Kaiser Permanente, South Bay, 25821 S Vermont Avenue, Harbor City, CA 90710, USA. Ronald.A.Navarro@kp.org
authors: Ronald A
authors: RA
authors: Navarro
authors: Maria C S
authors: MC
authors: Inacio
authors: Mary F
authors: MF
authors: Burke
authors: John G
authors: JG
authors: Costouros
authors: Edward H
authors: EH
authors: Yian
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D002140:California / Q000453:epidemiology; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006801:Humans; D015994:Incidence; D007595:Joint Prosthesis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011474:Prosthesis Design; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality
references: Clin Orthop Relat Res. 2006 Jul;448:152-6
references: 16826110
references: J Bone Joint Surg Am. 2012 Apr 18;94(8):746-7
references: 22517391
references: J Arthroplasty. 2001 Apr;16(3):400-3
references: 11307142
references: J Bone Joint Surg Am. 2002 Nov;84(11):1939-41
references: 12429752
references: J Shoulder Elbow Surg. 2007 May-Jun;16(3 Suppl):S2-8
references: 17493556
references: J Shoulder Elbow Surg. 2009 Jan-Feb;18(1):100-6
references: 19095183
references: JAMA. 2012 Jan 18;307(3):294-303
references: 22253396
references: J Shoulder Elbow Surg. 1997 Sep-Oct;6(5):486-90
references: 9356939
references: Arthroscopy. 2003 Nov;19(9):E129-32
references: 14608339
references: Am J Manag Care. 2011 Jul;17 Suppl 9:S251-8
references: 21819165
references: Orthop Rev. 1989 Nov;18(11):1173-5
references: 2812862
references: J Bone Joint Surg Am. 2005 Sep;87(9):2086-90
references: 16140825
references: J Shoulder Elbow Surg. 2011 Jul;20(5):764-70
references: 21420324
references: J Bone Joint Surg Am. 2012 Apr 18;94(8):714-20
references: 22517387