Venous thromboembolism in patients undergoing shoulder surgery: Findings from the RECOS Registry

Background Limited informations are available about venous thromboembolic (VTE) complications and thromboprophylaxis use after shoulder surgery. The primary end-point of the study was to determine the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) within 90 days after shoulder surgery. Risk factors for VTE and thromboprophylaxis practices were also studied. Methods RECOS is a prospective multicenter registry of consecutive patients undergoing shoulder surgery recruited in nine hospitals in Italy. Cumulative rates of VTE were estimated according to the Kaplan-Meier method; a Cox regression model was used to calculate adjusted hazard ratio (HR) and 95% confidence interval (CI) for some variables that were identified as risk factors for VTE. Results From June 2009 to June 2011 1366 patients (males 54.4%; mean age 55,65 ± 15.3 years) were enrolled. The surgical procedures were: arthroscopy (71.9%), hemiarthroplasty (17.2%) total replacement (8.9%), fixation for proximal humeral fracture (2%). After 90 days, the incidence of symptomatic VTE was 0.66% (95CI% 0.2-1.12). Mean age was significantly higher in patient with than in patients without VTE (67,1 +/3.49 years vs 55,6 +/- 0,42 years, respectively; p = 0.024). Duration of surgery > 60 minutes (HR:10.99; 95CI% 1.26-95.89; p = 0.030) was found as independent risk factor for VTE, while cancer, medical disease, venous insufficiency and previous VTE were not. Pharmacological thromboprophylaxis was prescribed in 33.5% (n = 457) of the patients, in 95.8% of whom for a duration > 10 days. Conclusions The risk of symptomatic VTE in patients undergoing shoulder surgery is low. The potential need for thromboprophylaxis should be based on a case by case evaluation.