Thromboembolic phenomena after arthroscopic shoulder surgery

Marshall A Kuremsky, E Lyle Cain, James E Fleischli
Arthroscopy 2011, 27 (12): 1614-9

PURPOSE: The purpose of this study was to review a series of patients who experienced thromboembolic events after shoulder arthroscopy and attempt to identify possible risk factors or associations with thromboembolic phenomena after shoulder arthroscopy.

METHODS: After institutional review board approval, a retrospective database review from 2 fellowship-trained surgeons over a 5-year consecutive period was conducted to identify all patients who underwent shoulder arthroscopy (N = 1,908). Six patients were identified as sustaining thromboembolic events after shoulder arthroscopy (5 deep vein thromboses [DVTs] and 4 pulmonary embolisms [PEs]), but there were no deaths. Patient demographics (age, gender, significant medical history, and body mass index), operative detail (concomitant procedures, positioning, and DVT prophylaxis), and diagnosis and treatment of the thromboembolic events (Doppler ultrasound/chest computed tomography, hypercoagulability testing, and treatment with Coumadin [Bristol-Myers Squibb, New York, NY]) were recorded.

RESULTS: Over a 5-year period, from 2002 to 2006, there were 6 patients known to have had thromboembolic events (5 documented DVTs and 4 PEs) after shoulder arthroscopy at the 2 institutions participating in the study. The total number of shoulder arthroscopies performed was 1,908. The mean patient age was 47 years (range, 18 to 71 years). All patients were evaluated with Doppler ultrasound, chest radiography, and chest computed tomography. Patients were treated with Coumadin, after bridging with low-molecular weight heparin. For the 5 documented DVTs, all lesions occurred on the same side as the operated extremity. There were 3 upper extremity lesions and 2 lower extremity lesions.

CONCLUSIONS: Postoperative DVT and PE are unusual and potentially fatal consequences of arthroscopic shoulder surgery. We report a low prevalence (0.31%), but all patients in this series required hospitalization and subsequent anticoagulation. All patients who had arthroscopic shoulder surgery during this study period-those with and without thromboembolic events-were in the lateral decubitus position with arm traction. Thromboembolic complications included both ipsilateral upper and lower extremity DVTs, as well as a high percentage of PEs (4 of 6 patients). A wide age range was seen in the patients with thromboembolic complications, and 3 of the patients had known identifiable risk factors.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.

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