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Budin JS, Ramos T, Segel K, Rumps MV, Mulcahey MK. Venous Thromboembolism Chemical Prophylaxis in Patients Undergoing Shoulder Arthroscopy. JBJS Rev 2024; 12:01874474-202403000-00007. [PMID: 38466802 DOI: 10.2106/jbjs.rvw.23.00228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
» Venous thromboembolism (VTE) after shoulder arthroscopy is rare (0.01%-0.38%) but impacts a significant number of patients because of the high procedure volume.» Studies found no significant benefit in reducing VTE risk with aspirin or low-molecular-weight heparins.» Current guidelines for thromboprophylaxis in shoulder arthroscopy lack consensus and need patient-specific considerations.» Further research is required to develop evidence-based thromboprophylaxis guidelines for shoulder arthroscopy.
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Affiliation(s)
- Jacob S Budin
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Tolulope Ramos
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Kalli Segel
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Mia V Rumps
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
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Wang Y, Li Q, Zhou Y, Dong Y, Li J, Liang T. A systematic review of risk prediction model of venous thromboembolism for patients with lung cancer. Thorac Cancer 2024; 15:277-285. [PMID: 38233997 PMCID: PMC10834197 DOI: 10.1111/1759-7714.15219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) increases the risk of death or adverse outcomes in patients with lung cancer. Therefore, early identification and treatment of high-risk groups of VTE have been the research focus. In this systematic review, the risk assessment tools of VTE in patients with lung cancer were systematically analyzed and evaluated to provide a reference for VTE management. METHODS Relevant studies were retrieved from major English databases (The Cochrane Library, Embase, Web of Science, PubMed, Scopus, Medline) and Chinese databases (China National Knowledge Infrastructure [CNKI] and WanFang Data) until July 2023 and extracted by two researchers. This systematic review was registered at PROSPERO (no. CRD42023409748). RESULTS Finally, two prospective cohort studies and four retrospective cohort studies were included from 2019. There was a high risk of bias in all included studies according to the Prediction Model Risk of Bias Assessment tool (PROBAST). In the included studies, Cox and logistic regression were used to construct models. The area under the receiver operating characteristic curve (AUC) of the model ranged from 0.670 to 0.904, and the number of predictors ranged from 4 to 11. The D-dimer index was included in five studies, but significant differences existed in optimal cutoff values from 0.0005 mg/L to 2.06 mg/L. Then, three studies validated the model externally, two studies only validated the model internally, and only one study validated the model using a combination of internal and external validation. CONCLUSION VTE risk prediction models for patients with lung cancer have received attention for no more than 5 years. The included model shows a good predictive effect and may help identify the risk population of VTE at an early stage. In the future, it is necessary to improve data modeling and statistical analysis methods, develop predictive models with good performance and low risk of bias, and focus on external validation and recalibration of models.
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Affiliation(s)
- Yan Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Qiuyue Li
- School of NursingPeking Union Medical CollegeBeijingChina
| | - Yanjun Zhou
- Department of Nursing, Beijing Children's HospitalCapital Medical University, National Center for Children's HealthBeijingChina
| | - Yiting Dong
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Jinping Li
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Tao Liang
- School of NursingPeking Union Medical CollegeBeijingChina
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Posner AD, Kuna MC, Carroll JD, Perloff EM, Anderson MJ, Hutchinson ID, Zimmerman JP. Anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid: 90-day complication profile in the inpatient versus outpatient setting. Clin Shoulder Elb 2023; 26:380-389. [PMID: 37957884 DOI: 10.5397/cise.2023.00479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/19/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients. METHODS A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups. RESULTS One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39-90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups. CONCLUSIONS TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting. Level of evidence: IV.
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Affiliation(s)
- Andrew D Posner
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Michael C Kuna
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Jeremy D Carroll
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Eric M Perloff
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Matthew J Anderson
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Ian D Hutchinson
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Joseph P Zimmerman
- Department of Orthopedic Surgery, Albany Medical Center, Albany, NY, USA
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Li T, Li Y, Zhang L, Pang L, Tang X, Zhu J. Venous thromboembolism after arthroscopic shoulder surgery: a systematic review. J Orthop Surg Res 2023; 18:103. [PMID: 36788620 PMCID: PMC9927062 DOI: 10.1186/s13018-023-03592-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To summarize the incidence, risk factors, diagnosis methods, prophylaxis methods, and treatment of venous thromboembolism (VTE) following arthroscopic shoulder surgery. METHODS Literature on VTE after arthroscopic shoulder surgeries was summarized, and all primary full-text articles reporting at least 1 case of deep vein thrombosis (DVT) or pulmonary embolism (PE) after arthroscopic shoulder surgeries were included. Articles were critically appraised and systematically analyzed to determine the incidence, risk factors, diagnosis, prophylaxis, and management of VTE following arthroscopic shoulder surgeries. RESULTS This study included 42 articles in which the incidence of VTE ranges from 0 to 5.71% and the overall incidence was 0.26%. Most VTE events took place between the operation day and the 14th day after the operation (35/51). Possible risk factors included advanced age (> 70 years), obesity (BMI ≥ 30 kg/m2), diabetes mellitus, thrombophilia, history of VTE, prolonged operation time, hormone use, and immobilization after surgery. The most common prophylaxis method was mechanical prophylaxis (13/15). No statistical difference was detected when chemoprophylaxis was applied. The management included heparinization followed by oral warfarin, warfarin alone and rivaroxaban, a direct oral anticoagulant. CONCLUSION Based on the included studies, the incidence rate of VTE after arthroscopic shoulder surgeries is relatively low. The risk factors for VTE are still unclear. CT/CTA and ultrasound were the mainstream diagnosis methods for PE and DVT, respectively. Current evidence shows that chemical prophylaxis did not deliver significant benefits, since none of the existing studies reported statistically different results. High-quality studies focusing on the prophylaxis and management of VTE population undergoing arthroscopic shoulder surgeries should be done in the future.
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Affiliation(s)
- Tao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Yinghao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Linmin Zhang
- grid.13291.380000 0001 0807 1581West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Long Pang
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Nursing, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, Sichuan Province, People's Republic of China.
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Kim DH, Na SS, Park UJ, Cho CH. Is Routine Screening Using Duplex Ultrasonography for Deep Vein Thrombosis Necessary after Shoulder Arthroplasty? Diagnostics (Basel) 2023; 13:diagnostics13040636. [PMID: 36832124 PMCID: PMC9955511 DOI: 10.3390/diagnostics13040636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
The aims of this study were to examine the incidence, risk factors, and outcomes of deep vein thrombosis (DVT) after shoulder arthroplasty in Korean patients. A total of 265 patients who underwent shoulder arthroplasty were included. The mean age of the patients was 74.6 years, and there were 195 females and 70 males. Clinical data including patient demographics, blood tests, and previous and current medical history were investigated. For screening of DVT, duplex ultrasonography of the operative arm was performed 2 to 5 days after surgery. Of the 265 patients, 10 patients (3.8%) were diagnosed with DVT using postoperative duplex ultrasonography. There were no cases of pulmonary embolism. There were no significant differences between the DVT and no DVT groups regarding all clinical data, except for the Charlson comorbidity index (CCI), which was significantly higher in the DVT group than in the no DVT group (5.0 vs. 4.1; p = 0.029). All patients had asymptomatic DVT that showed complete resolution after administration of antithrombotic agents or close observation without medications. The overall incidence of DVT was 3.8% during a period of 3 months after shoulder arthroplasty in Korean patients, and most cases were asymptomatic. Routine screening for DVT using duplex ultrasonography after shoulder arthroplasty may not be necessary except in patients with high CCI.
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Affiliation(s)
- Du-Han Kim
- Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubul-ro, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Sang-Soo Na
- Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubul-ro, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Ui-Jun Park
- Department of Vascular Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubul-ro, Dalseo-gu, Daegu 42601, Republic of Korea
| | - Chul-Hyun Cho
- Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubul-ro, Dalseo-gu, Daegu 42601, Republic of Korea
- Correspondence: ; Tel.: +82-53-258-4771
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Gouzoulis MJ, Joo PY, Kammien AJ, McLaughlin WM, Yoo B, Grauer JN. Risk factors for venous thromboembolism following fractures isolated to the foot and ankle fracture. PLoS One 2022; 17:e0276548. [PMID: 36264985 PMCID: PMC9584400 DOI: 10.1371/journal.pone.0276548] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Venous thromboembolism (VTE) is an uncommon, but potentially morbid, complication following foot and ankle fractures. Current standard is to not administer thromboprophylaxis to patients with such injuries. Nonetheless, patient and fracture factors might affect this risk/benefit consideration. The goal of this study was to determine what patients are most at risk. METHODS The M53Ortho Pearldiver database was used to identify patients with fractures isolated to the foot and ankle that were treated non-operatively or operatively. Patients with pilon, other appendicular fractures remote from the foot and ankle, and other traumatic injuries were excluded. The 90-day occurrence of VTE was identified based on codes for deep vein thrombosis or pulmonary embolism. Characteristics of those patients who did and did not have VTEs were compared using chi-square analyses. Multivariate logistical regression was then performed to determined factors independently associated with VTE. Finally, timing of VTE relative to fracture was analyzed. RESULTS A total of 298,886 patients with isolated foot or ankle fractures were identified, of which 1,661 (0.56%) had VTE in the 90 days following fracture. In terms of timing, 27.3% occurred in the first week, and 49.8% occurred in the first three weeks. Independent risk factors for VTE included (in decreasing order):prior VTE (odd ratio [OR] = 25.44), factor V Leiden (OR = 24.34), active cancer (OR = 1.84), specific fracture relative to metatarsal fracture (multiple fractures [OR: 1.51], ankle fracture [OR = 1.51], and calcaneus fracture [OR = 1.24]), surgical treatment (OR = 1.41), male sex (OR = 1.19), greater Elixhauser index (OR = 1.05), and increasing age (OR:1.05 per decade) (p<0.05 for each). CONCLUSIONS The present study found that, although only 0.56% of isolated foot and ankle fractures had a VTE within ninety days. Defined risk factors, such as Factor V Leiden, prior VTE, surgical treatment, active cancer, specific fracture patterns, and surgical treatment significantly affected the odds of their occurrence.
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Affiliation(s)
- Michael J. Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Peter Y. Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Alexander J. Kammien
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - William M. McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Brad Yoo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
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Venous Thromboembolism After Total Shoulder Arthroplasty: A Database Study of 31,918 Cases. J Am Acad Orthop Surg 2022; 30:949-956. [PMID: 36135929 DOI: 10.5435/jaaos-d-22-00352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a rare but serious complication of total shoulder arthroplasty (TSA). Owing to limited evidence, Clinical Practice Guideline recommendations for VTE chemoprophylaxis after TSA rely heavily on the risk stratification of individual patients. The objectives of this study were to identify the prevalence and risk factors independently associated with VTE, PE, and DVT in the 30-day postoperative period after TSA. METHODS A retrospective case-control study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database by querying the Current Procedural Terminology code for total shoulder arthroplasty from 2011 to 2020. The initial query resulted in 33,089 patients. After applying exclusion criteria for age younger than 50 years, emergency surgery, and open wound or infection, a final cohort of 31,918 patients who underwent TSA were included. The primary outcome was venous thromboembolism, and secondary outcome variables were PE and DVT. A bivariate screen was done for explanatory variables associated with our outcome variables, and variables with P < 0.1 in the bivariate screen were included in a multivariable logistic regression model. RESULTS Of the 31,918 patients in our cohort, 183 patients (0.573%) developed VTE, 92 patients (0.29%) developed PE, and 104 patients (0.326%) developed DVT during the 30-day postoperative period. Multivariable logistic regression analysis showed that older age, higher body mass index, longer surgical time, and longer hospital length of stay were associated with VTE and PE and that hypertension and shorter hospital length of stay were associated with DVT. DISCUSSION The prevalence of VTE after TSA is low. Older patients, patients with higher body mass index, and patients with longer surgical durations are at higher risk for VTE after TSA. Our findings are relevant for preoperative risk stratification and the decision for chemoprophylaxis. LEVEL OF EVIDENCE Level III Prognostic.
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Na SS, Kim DH, Choi BC, Cho CH. Incidence, characteristics, and risk factors of venous thromboembolism in shoulder arthroplasty-a systematic review. INTERNATIONAL ORTHOPAEDICS 2022; 46:2081-2088. [PMID: 35761099 DOI: 10.1007/s00264-022-05496-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to investigate the incidence, characteristics, and risk factors for venous thromboembolism (VTE) in patients who underwent shoulder arthroplasty (SA) through systematic review. METHODS A search of studies was conducted using the databases for PubMed, EMBASE, Scopus, Ovid, MEDLINE, and Cochrane Library according to the guidelines for PRISMA (Preferred Reporting Items for Systematic Meta-Analyses). Quality assessment was performed using the Methodological Index for Nonrandomized Studies (MINORS). RESULTS Nine studies (12,566 shoulders) were finally eligible and the mean MINORS score was 13.2 (ranges, 9-18). The overall incidence of VTE was 0.81% (78/9681) including 0.54% (52/9681) for deep vein thrombosis (DVT) and 0.33% (42/12,566) for pulmonary embolism (PE). There were no significant differences in the incidences according to the type of arthroplasty. DVT was detected at an average of 18.8 days after index surgery, and PE was detected at an average of 12.7 days after index surgery. The risk factors for VTE included age older than 70 years, higher BMI, raised Charlson Comorbidity Index, history of DVT, asthma, cardiac arrhythmia, diabetes, lower haemoglobin level, use of general endotracheal anaesthesia without interscalene nerve block, traumatic indication, longer operative time, and revision SA. The mortality rate was 4.1% (2/49) for VTE and 8.3% (2/24) for PE. CONCLUSION Despite the fact that the overall incidence of VTE following SA was as low as 0.81%, shoulder surgeons should consider the potential for this serious complication in high-risk patients. Further well-designed large-scale studies are necessary to clarify the consensus for VTE after SA including risk factors, treatment, and prophylaxis.
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Affiliation(s)
- Sang-Soo Na
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea
| | - Byung-Chan Choi
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, South Korea.
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King HE, Ricketts D, Roper T, Phadnis J. Few UK vascular centres offer a fully NICE-compliant supervised exercise programme: a national audit. Ann R Coll Surg Engl 2022; 104:130-137. [PMID: 34982604 PMCID: PMC9246563 DOI: 10.1308/rcsann.2021.0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To determine the current (pre-COVID-19) provision of supervised exercise training (SET) for patients with peripheral arterial disease (PAD) in UK Vascular Centres. METHODS Hospital Trusts delivering vascular care to patients with PAD were identified from the National Vascular Registry and asked to complete an online questionnaire on their provisions for SET. If a centre offered SET, they were asked questions to determine whether the programme was compliant with NICE guidelines and the difficulties they faced delivering the service. If centres did not offer SET, they were asked what obstacles prevented them implement SET. RESULTS Of the 78 UK vascular centres, 59 (76%) responded and were included in the audit. Of these, 27 (46%) were able to offer SET but only 21 (36%) could offer it to all their patients with PAD. Only four (6.8%) offered SET that was fully compliant with current NICE guidelines. Reasons identified included insufficient funding, lack of resource and poor patient compliance. CONCLUSIONS The benefits of SET are well established yet the availability of the service in the UK is poor. The reasons for this are readily identified but have not yet been overcome. Research on novel methods of delivering supervised exercise that mitigates existing barriers, such as home exercise with remote monitoring, should be prioritised to facilitate optimal management for our patients with PAD.
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Affiliation(s)
- HE King
- University Hospitals Sussex NHS Foundation Trust, UK
| | | | - T Roper
- University Hospitals Sussex NHS Foundation Trust, UK
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11
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Abstract
Orthopedic sports surgery of the knee and shoulder is generally considered to be safe and effective. Vascular complications can occur during or after arthroscopy of either joint. A thorough understanding of anatomy, particularly when placing portals in non-routine locations, is extremely important. Prompt recognition of any vascular complication is of significant importance. This review will discuss the potential vascular complications for both knee and shoulder sports surgery, review the relevant anatomy, and discuss the treatment and expected outcome of each.
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Kirsch JM, Gutman M, Patel M, Rondon A, Ramsey ML, Abboud JA, Williams GR, Namdari S. Low-dose aspirin and the rate of symptomatic venous thromboembolic complications following primary shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:1613-1618. [PMID: 33536125 DOI: 10.1016/j.jse.2020.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) events are infrequent but potentially catastrophic complications following orthopedic surgery. There is currently a paucity of evidence regarding the role of chemoprophylaxis with low-dose aspirin (acetylsalicylic acid [ASA]) after shoulder arthroplasty. METHODS We conducted a retrospective review of prospectively collected complications occurring within 90 days of 2394 primary shoulder arthroplasties performed over a 3-year period at a single institution. Patients preoperatively underwent risk stratification into medically high risk, moderate risk, or low risk as part of a standardized navigated-care pathway. For chemoprophylaxis, 81 mg of ASA (low dose) was routinely used once daily for 6 weeks unless alternative medications were deemed necessary by the medical team. Baseline demographic information, medical comorbidities, and postoperative VTE prophylaxis, as well as rates of clinically symptomatic VTE, were assessed. RESULTS Symptomatic VTE occurred after 0.63% of primary shoulder arthroplasties (15 of 2394). There were 9 patients with deep vein thromboses and 6 with pulmonary embolisms. Eighty-one milligrams of ASA was used in 2141 patients (89.4%), resulting in an overall VTE rate of 0.56%. Medically high-risk patients were significantly more likely to have a VTE (P = .018). Patients with a history of deep vein thrombosis, asthma, and cardiac arrhythmia were significantly more likely to have a VTE (P < .05). Complications occurred in 4 patients (0.19%) associated with low-dose ASA and 1 patient (0.63%) associated with a novel oral anticoagulant medication. CONCLUSION Routine use of low-dose ASA results in a very low risk of VTE and medication-associated complications following primary shoulder arthroplasty. Preoperative medical risk stratification can potentially identify patients at high risk of postoperative VTE.
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Affiliation(s)
- Jacob M Kirsch
- Department of Orthopaedic Surgery, The Rothman Institute-Thomas Jefferson, Philadelphia, PA, USA
| | - Michael Gutman
- Department of Orthopaedic Surgery, The Rothman Institute-Thomas Jefferson, Philadelphia, PA, USA
| | - Manan Patel
- Department of Orthopaedic Surgery, The Rothman Institute-Thomas Jefferson, Philadelphia, PA, USA
| | - Alex Rondon
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew L Ramsey
- Department of Orthopaedic Surgery, The Rothman Institute-Thomas Jefferson, Philadelphia, PA, USA
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, The Rothman Institute-Thomas Jefferson, Philadelphia, PA, USA
| | - Gerald R Williams
- Department of Orthopaedic Surgery, The Rothman Institute-Thomas Jefferson, Philadelphia, PA, USA
| | - Surena Namdari
- Department of Orthopaedic Surgery, The Rothman Institute-Thomas Jefferson, Philadelphia, PA, USA.
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Bilateral pulmonary embolism without deep venous thrombosis was observed after knee arthroscopy: a case report. BMC Musculoskelet Disord 2021; 22:383. [PMID: 33894744 PMCID: PMC8070294 DOI: 10.1186/s12891-021-04266-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/15/2021] [Indexed: 12/30/2022] Open
Abstract
Background Symptomatic pulmonary embolism (PE) after knee arthroscopy is extremely rare. If the embolism is not treated promptly, the patient may die. Bilateral pulmonary embolism with associated pulmonary infarct without concomitant deep vein thrombosis has never been reported following routine knee arthroscopy. Case presentation A 50-year-old female patient with no other risk factors other than hypertension, obesity, varicose veins in the ipsilateral lower extremities and elevated triglyceride (TG) presented to our ward. She had experienced sudden chest tightness, polypnea and fainting after going to the bathroom the morning of the second postoperative day and received emergency medical attention. Colour ultrasonography of the extremities showed no deep vein thrombosis. Lung computed tomography angiography (CTA) showed multiple embolisms scattered in both pulmonary artery branches. Thus, emergency interventional thrombolysis therapy was performed, followed by postoperative symptomatic treatment with drugs with thrombolytic, anticoagulant and protective activities. One week later, lung CTA showed a significant improvement in the PEs compared with those in the previous examination. Since the aetiology of PE and no obvious symptoms were discerned, the patient was discharged. Conclusion Although knee arthroscopy is a minimally invasive and quick procedure, the risk factors for PE in the perioperative period should be considered and fully evaluated to enhance PE detection. Moreover, a timely diagnosis and effective treatment are important measures to prevent and cure PE after knee arthroscopy. Finally, clear guidelines regarding VTE thromboprophylaxis following knee arthroscopy in patients with a low risk of VTE development are needed.
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Venous thromboembolism following 672,495 primary total shoulder and elbow replacements: Meta-analyses of incidence, temporal trends and potential risk factors. Thromb Res 2020; 189:13-23. [DOI: 10.1016/j.thromres.2020.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 12/14/2022]
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Lung BE, Kanjiya S, Bisogno M, Komatsu DE, Wang ED. Risk factors for venous thromboembolism in total shoulder arthroplasty. JSES OPEN ACCESS 2019; 3:183-188. [PMID: 31709360 PMCID: PMC6834973 DOI: 10.1016/j.jses.2019.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Although venous thromboembolism (VTE) has been studied in lower-extremity arthroplasty, there are few guidelines regarding established risk factors for VTE in total shoulder arthroplasty (TSA). With literature suggesting the VTE rate may be as high as 13%, VTE prevention and risk factors should be considered in preoperative planning. METHODS All TSAs from 2011 through 2016 were queried from the National Surgical Quality Improvement Program database. Age, sex, body mass index, American Society of Anesthesiologists class, ethnicity, functional status, comorbidities, discharge destination, surgical indication, length of stay, and operative time were compared between patients with and without 30-day postoperative VTE. Pearson χ2 and t tests were used to assess baseline categorical and continuous variables, respectively. Multivariate logistic regression analysis was conducted to determine associated independent risk factors for VTE. RESULTS The analysis included 13,299 patients; VTE developed in 83 patients (0.62%). Patients with VTE were older (72 years vs. 69 years) and had a longer hospital stay (3.5 days vs. 1.9 days). Compared with patients with no VTE, patients with VTE were more likely to undergo TSA for proximal humeral fractures, to be discharged to a rehabilitative center, to have a preoperative albumin level lower than 3.5 g/dL, to undergo non-elective surgery, to have an American Society of Anesthesiologists class of 3 or greater, to have a surgical-site infection develop, and ultimately to need a shoulder reoperation (all P < .05). Multivariate logistic regression analysis revealed that hypoalbuminemia (albumin level < 3.5 g/dL), an increased length of stay, and African American ethnicity were independent risk factors for VTE development. CONCLUSION Patients with hypoalbuminemia, an increased length of stay, and African American ethnicity are at an increased risk of VTE after shoulder arthroplasty. A high index of suspicion is warranted for elderly patients with fractures who may need preoperative medical optimization.
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Affiliation(s)
- Brandon E. Lung
- School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Shrey Kanjiya
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Michael Bisogno
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
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