In contrast to arthroscopic knee surgery, deep venous thrombosis and pulmonary embolism after arthroscopic shoulder surgery are infrequent events. The purpose of this study was to review a case series of patients who sustained thromboembolic events and attempt to identify risk factors associated with this unusual complication.
A retrospective database review was performed to identify patients. Search strings for postoperative complications included emergency room visit or hospital admission for deep venous thrombosis (DVT) or pulmonary embolism (PE). Seven total patients were identified in a two-year period.
Over a four-year period, two surgeons performed 2872 arthroscopic shoulder surgeries. A total of 7 cases (0.24%) of thromboembolic disease were identified in our healthcare system, with 5 cases of DVT and 2 cases of PE. The average patient age was 44 years (range, 18-61). All patients were diagnosed with Doppler ultrasound, admitted as inpatients for initial therapy and workup, and treated with coumadin for a minimum of 3 months. All patients underwent hypercoagulability testing; one patient had protein C deficiency while another had protein S deficiency. There were no fatalities associated with these complications. Six patients were placed in the lateral decubitus position and one patient was placed in the modified-beach chair position (p<0.05) during arthroscopic shoulder surgery. Of interest, five of these seven events involved the operative upper extremity (71%), and two of these seven events (29%) involved the ipsilateral lower extremity. Six patients underwent rotator cuff repair, 5 patients underwent subacromial decompression, and three patients had distal clavicle resections. Five patients were smokers, and two were worker’s compensation.
Postoperative deep venous thrombosis and pulmonary embolism are unusual but serious and potentially fatal consequences of arthroscopic shoulder surgery. We report a low incidence of just 0.24%, but all patients in this series required hospitalization and anticoagulation therapy. Despite the small size of this cohort, there was an association with patient positioning in the lateral decubitus position. It remains critical to be aware of this potential complication, and further investigation is necessary to determine if mechanical or pharmacologic DVT prophylaxis after arthroscopic shoulder surgery would be beneficial.
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.