Venous thromboembolism in patients undergoing shoulder surgery: findings from the Recos registry

Background: Sparse informations are available about venous thrombo-embolic (VTE) complications after different types of shoulder surgery. Aim: 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 of follow-up in patients undergoing 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. Patients were followed-up at 7, 30 and 90 days for major clinical outcomes. Cumulative rates of VTE were estimated according to the Kaplan-Meier method; a Cox regression model was used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for some variables that were identified as potential risk factors for VTE. Results: From June 2009 to June 2011 1366 evaluable patients (males 54.4%; mean age 55.65  15.3 years) were enrolled in the registry. The shoulder surgical procedures were the following: arthroscopy (72%), arthrotomy (19.1%) total replacement (8.9%). After 90 days, the incidence rate (95% CI) of symptomatic DVT and PE was 0.7% (95CI% 0.2–11.2). Mean age of patient with VTE complications was significantly different from patients who did not displayed complications (55.6  0.42 vs. 25.7  0.2, P = 0.024). Duration of surgery > 60 min (HR: 10.99; 95CI% 1.26–95.89; P = 0.030) was found as independent risk factor for VTE. Pharmacological thromboprophylaxis was prescribed in 33.5% (n = 457) of the patients; in 95.8% of them the recommended duration of prophylaxis was > 10 days. Conclusions: The risk of symptomatic VTE in patients undergoing shoulder surgery is not negligible. This risk and the potential need for thromboprophylaxis should be taken into account by orthopaedic surgeons.