Risk of Thromboembolism in Shoulder Arthroplasty: Effect of Implant Type and Traumatic Indication
Autor: | Edward H. Yian, Maria C.S. Inacio, John G. Costouros, Mary F. Burke, Ronald A. Navarro |
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Přispěvatelé: | Navarro, Ronald A, Inacio, Maria CS, Burke, mary F, Costouros, J G, Yian, E H |
Rok vydání: | 2013 |
Předmět: |
Male
musculoskeletal diseases medicine.medical_specialty Time Factors Treatment O Sports medicine Joint Prosthesis medicine.medical_treatment Replacement Prosthesis Design Risk Assessment California Arthroplasty Risk Factors Clinical Research medicine Humans Orthopedics and Sports Medicine cardiovascular diseases Arthroplasty Replacement Aged Venous Thrombosis Chi-Square Distribution Shoulder Joint business.industry Incidence Retrospective cohort study Venous Thromboembolism General Medicine equipment and supplies medicine.disease Surgery Pulmonary embolism Venous thrombosis medicine.anatomical_structure Elective Surgical Procedures Anesthesia Orthopedic surgery Female Shoulder joint Emergencies Pulmonary Embolism business human activities Shoulder replacement |
Zdroj: | Clinical Orthopaedics & Related Research. 471:1576-1581 |
ISSN: | 0009-921X |
Popis: | 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. Level of Evidence: Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence. Refereed/Peer-reviewed |
Databáze: | OpenAIRE |
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