title: Venous thromboembolism incidence in upper limb orthopedic surgery: do these procedures increase venous thromboembolism risk?
abstract: BACKGROUND
  In 2005, the House of Commons (HoC) Health Committee stated deaths attributed to preventable, hospital-acquired venous thromboembolism (VTE) numbered upwards of 25,000 per annum. Nationwide prevention of VTE became the topic of a major health campaign. The HoC Health Committee stated there was an unstratified VTE risk of between 45% and 51% associated with orthopedic surgery. VTE research in orthopedic surgery has been concentrated on lower limb procedures. Experience suggests that this kind of relation does not hold true for upper limb orthopedic procedures. This project aimed to estimate the incidence of postoperative VTE in upper limb orthopedic surgery.
  
  
  METHODS
  The incidence of postoperative VTE was assessed in 3357 consecutive upper limb orthopedic operations performed by 4 surgeons in Lancashire Teaching Hospitals National Health Service (NHS) Trust (LTHTR) between July 1, 2009, and July 31, 2012.
  
  
  RESULTS
  Four pulmonary embolisms and 2 deep vein thromboses occurred. Incidence of postoperative VTE was 0.0018%, significantly lower than rates reported in the literature. Five of 6 patients who developed a VTE reported a personal or family history of VTE. Three patients would not have been identified as at risk under the current VTE screening guidelines. Three of these patients received appropriate anticoagulation according to present guidelines, yet VTE events still occurred.
  
  
  CONCLUSIONS
  These results indicate VTE risk in orthopedic upper limb surgery is much lower than reported in the literature. The necessity for screening for VTE in upper limb surgery is contested. The efficacy of VTE screening and current VTE prophylaxis is discussed, and an alternative and much simplified method of screening is suggested.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Preston, Lancashire, UK. Electronic address: grhastie@doctors.org.uk.
authors.forename: Graham R
authors.initials: GR
authors.lastname: Hastie
authors.affiliation: Manchester Medical School, The University of Manchester, Manchester, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Pederson
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Preston, Lancashire, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Redfern
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D034941:Upper Extremity / Q000601:surgery*; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology
keywords: DVT; PE; prophylaxis; upper limb surgery