Saturday, June 20, 2015

Shoulder joint replacement arthroplasty - pulmonary embolism in hospital

Factors associated with in-hospital pulmonary embolism after shoulder arthroplasty.

These authors used the Nationwide Inpatient Sample to gather a sample of 422,372 patients having shoulder arthroplasty between 2002 and 2011. This population was divided into 2 groups: those who experienced perioperative PE (0.25%) and those who did not.

The top 4 independent predictors for PE were primary diagnosis of proximal humerus fracture, deficiency anemia, congestive heart failure, and chronic lung disease. Other pertinent risk factors included increasing age, obesity, fluid and electrolyte abnormalities, undergoing total shoulder arthroplasty rather than hemiarthroplasty, and subsequent days of postoperative care. Individuals having pulmonary emboli had a death rate of 5% in comparison to 0.1% in those without.

Comment: An often asked question is whether thromboembolic prophylaxis shoulder be used after shoulder joint replacement arthroplasty. While these authors identified a number of risk factors as summarized in the table below, they were unable to include some of the most important identified risk factors for pulmonary embolism: prior history of pulmonary embolism or deep venous thrombosis, cancer, smoking, and supplemental estrogen.

The use of preoperative prophylactic anticoagulation for shoulder arthroplasty cannot be taken lightly because of the increased risk of hematoma, would drainage, infection, swelling, pain, and stiffness. Based on an understanding of each patient's factors, the surgeon must balance the risks of thromboembolism versus the risks of anticoagulation.


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