Advertisement

Timing and Risk Factors for Venous Thromboembolism After Rotator Cuff Repair in the 30-Day Perioperative Period

Published:October 16, 2019DOI:https://doi.org/10.1016/j.arthro.2019.05.045

      Purpose

      To analyze the American College of Surgeons National Surgical Quality Improvement Program database to evaluate the incidence of deep venous thrombosis and pulmonary embolism in patients undergoing rotator cuff repair surgery. In addition, we aim to identify risk factors associated with the development of thromboembolic events following rotator cuff repair.

      Methods

      A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database was performed. Current Procedural Terminology codes were used to identify patients who underwent rotator cuff repair between 2005 and 2017. The presence of deep venous thrombosis or pulmonary embolism during the 30-day perioperative period were the primary outcomes assessed. Logistic regression analysis was performed to identify risk factors for postoperative venous thromboembolic events (VTEs).

      Results

      In total, 39,825 rotator cuff repairs (RCRs) were performed and 117 (0.3%) VTE events occurred. VTE was identified at a mean of 11.5 ± 7.4 days. A total of 31,615 RCRs were performed arthroscopically. There was no significant difference of VTE between groups comparing arthroscopic RCR VTE 0.3% (94) with open RCR 0.3% (23) (P = .81). RCR in patients with an American Society of Anesthesiologists classification of III or IV was associated with >1.5-fold increase risk of VTE (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.14-2.45). Increased risks of VTE included surgery >80 minutes (OR 2.10, 95% CI 1.42-3.15), performed under general anesthesia (OR 4.38, 95% CI 1.18-36.6), and in the outpatient setting (OR 6.09, 95% CI 1.06-243.7), male sex (OR 1.53, 95% CI 1.01-2.33), bleeding disorders (OR 2.87, 95% CI 1.17-7.05), or dyspnea (OR 1.51, 95% CI 1.02-2.23). The biggest risk for VTE was unplanned reoperation OR 16.6 (95% CI 5.13-53.5).

      Conclusions

      Venous thromboembolism is a rare complication following rotator cuff repair 0.3%. Understanding the risk factors: duration of surgery >80 minutes, male sex, body mass index >30 kg/m2, ASA III or IV, RCR as an inpatient under general anesthesia, bleeding disorder, or dyspnea may be useful in guiding treatment to prevent VTE. The largest risk for VTE is a patient with unplanned reoperation. RCR surgery performed in an outpatient setting resulted in a significantly lower incidence of VTE.

      Level of Evidence

      III Retrospective Comparative Study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Streiff M.B.
        • Brady J.P.
        • Grant A.M.
        • et al.
        CDC Grand Rounds: Preventing hospital-associated venous thromboembolism.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 190-193
        • Samama C.M.
        • Ravaud P.
        • Parent F.
        • Barre J.
        • Mertl P.
        • Mismetti P.
        Epidemiology of venous thromboembolism after lower limb arthroplasty: The FOTO study.
        J Thromb Haemost. 2007; 5: 2360-2367
        • White R.H.
        • Romano P.S.
        • Zhou H.
        • Rodrigo J.
        • Bargar W.
        Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty.
        Arch Intern Med. 1998; 158: 1525-1531
        • Paffrath T.
        • Wafaisade A.
        • Lefering R.
        • et al.
        Venous thromboembolism after severe trauma: incidence, risk factors and outcome.
        Injury. 2010; 41: 97-101
        • Shackford S.R.
        • Davis J.W.
        • Hollingsworth-Fridlund P.
        • Brewer N.S.
        • Hoyt D.B.
        • Mackersie R.C.
        Venous thromboembolism in patients with major trauma.
        Am J Surg. 1990; 159: 365-369
        • Lyman S.
        • Sherman S.
        • Carter T.I.
        • Bach P.B.
        • Mandl L.A.
        • Marx R.G.
        Prevalence and risk factors for symptomatic thromboembolic events after shoulder arthroplasty.
        Clin Orthop Relat Res. 2006; 448: 152-156
        • Jameson S.S.
        • James P.
        • Howcroft D.W.
        • et al.
        Venous thromboembolic events are rare after shoulder surgery: Analysis of a national database.
        J Shoulder Elbow Surg. 2011; 20: 764-770
        • Shortt N.L.
        • Robinson C.M.
        Mortality after low-energy fractures in patients aged at least 45 years old.
        J Orthop Trauma. 2005; 19: 396-400
        • Willis A.A.
        • Warren R.F.
        • Craig E.V.
        • et al.
        Deep vein thrombosis after reconstructive shoulder arthroplasty: A prospective observational study.
        J Shoulder Elbow Surg. 2009; 18: 100-106
        • O'Brien R.M.
        A caution regarding rules of thumb for variance inflation factors.
        Quality Quantity. 2007; 41: 673-690
        • Rockwood Jr., C.A.
        • Wirth M.A.
        • Blair S.
        Warning: Pulmonary embolism can occur after elective shoulder surgery-report of two cases and survey of the members of the American Shoulder and Elbow Surgeons.
        J Shoulder Elbow Surg. 2003; 12: 628-630
        • Garofalo R.
        • Notarnicola A.
        • Moretti L.
        • Moretti B.
        • Marini S.
        • Castagna A.
        Deep vein thromboembolism after arthroscopy of the shoulder: Two case reports and a review of the literature.
        BMC Musculoskelet Disord. 2010; 11: 65
        • Dattani R.
        • Smith C.D.
        • Patel V.R.
        The venous thromboembolic complications of shoulder and elbow surgery: A systematic review.
        Bone Joint J. 2013; 95-B: 70-74
        • Greene J.W.
        • Deshmukh A.J.
        • Cushner F.D.
        Thromboembolic complications in arthroscopic surgery.
        Sports Med Arthrosc. 2013; 21: 69-74
        • Madhusudhan T.R.
        • Sinha A.
        • Widdowson D.
        Deep vein thrombosis in shoulder arthroplasty—a prospective study.
        BMC Musculoskelet Disord. 2013; 14: 139
        • Imberti D.
        • Ivaldo N.
        • Murena L.
        • et al.
        Venous thromboembolism in patients undergoing shoulder surgery: Findings from the RECOS Registry.
        Thromb Res. 2014; 134: 273-277
        • Schick C.W.
        • Westermann R.W.
        • Gao Y.
        • Group A.
        • Wolf B.R.
        Thromboembolism following shoulder arthroscopy: A retrospective review.
        Orthop J Sports Med. 2014; 2 (2325967114559506)
        • Anderson Jr., F.A.
        • Spencer F.A.
        Risk factors for venous thromboembolism.
        Circulation. 2003; 107: I9-16
        • Montagnana M.
        • Favaloro E.J.
        • Franchini M.
        • Guidi G.C.
        • Lippi G.
        The role of ethnicity, age and gender in venous thromboembolism.
        J Thromb Thrombolysis. 2010; 29: 489-496
        • Heit J.A.
        • Spencer F.A.
        • White R.H.
        The epidemiology of venous thromboembolism.
        J Thromb Thrombolysis. 2016; 41: 3-14
        • Saleh H.E.
        • Pennings A.L.
        • ElMaraghy A.W.
        Venous thromboembolism after shoulder arthroplasty: A systematic review.
        J Shoulder Elbow Surg. 2013; 22: 1440-1448
        • Engelberger R.P.
        • Kucher N.
        Management of deep vein thrombosis of the upper extremity.
        Circulation. 2012; 126: 768-773