These authors examined the relationship between postoperative therapeutic anticoagulation, wound complications, infection, and revision using a national insurance database from 2007 to 2016
Those with a prescription for a therapeutic anticoagulant within 2 weeks of surgery were identified and compared with controls without postoperative therapeutic anticoagulant prescriptions.
A total of 17,272 patients were included, including 684 patients who received therapeutic anticoagulation and 16,588 controls.
Patients receiving therapeutic anticoagulation had increased risk of wound complications at 3 months (odds ratio [OR] 3.0, 95% confidence interval [CI] 2.0-4.6, P < .0001) and 6 months (OR 2.5, 95% CI 1.7-3.8, P < .0001).
Patients receiving therapeutic anticoagulation also experienced increased rates of wound infection at 3 months (OR 1.5, 95% CI 1.1-2.0, P ..007) and 6 months (OR 1.8, 95% CI 1.4-2.3, P <.0001).
Finally, patients receiving therapeutic anticoagulation experienced increased rates of revision surgery at 6 months (OR 1.8, 95% CI 1.3-2.5, P . .0003) and within 9 years (OR 1.5, 95% CI 1.1-2.0, P . .007).
Comment: The risks of anticoagulation are undeniable. We have found this program to be effective
(1) to ask the patient's cardiologist for each patient with atrial fibrillation if anticoagulation is really necessary - often it turns out not to be,
(2) to be meticulous about hemostasis,
(3) to use thrombogenic agents at the time of surgery (e.g. topical tranexamic acid, thrombin+gelfoam, etc),
(4) to close the wound with staples to allow drainage,
(5) to use a dressing with suction (see illustration below),
(5) to delay range of motion exercises until it is obvious that bleeding is under control, and
(6) to ask the patient and family to notify us promptly of increased swelling, pain or drainage.
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To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
A total of 17,272 patients were included, including 684 patients who received therapeutic anticoagulation and 16,588 controls.
Patients receiving therapeutic anticoagulation had increased risk of wound complications at 3 months (odds ratio [OR] 3.0, 95% confidence interval [CI] 2.0-4.6, P < .0001) and 6 months (OR 2.5, 95% CI 1.7-3.8, P < .0001).
Patients receiving therapeutic anticoagulation also experienced increased rates of wound infection at 3 months (OR 1.5, 95% CI 1.1-2.0, P ..007) and 6 months (OR 1.8, 95% CI 1.4-2.3, P <.0001).
Finally, patients receiving therapeutic anticoagulation experienced increased rates of revision surgery at 6 months (OR 1.8, 95% CI 1.3-2.5, P . .0003) and within 9 years (OR 1.5, 95% CI 1.1-2.0, P . .007).
Comment: The risks of anticoagulation are undeniable. We have found this program to be effective
(1) to ask the patient's cardiologist for each patient with atrial fibrillation if anticoagulation is really necessary - often it turns out not to be,
(2) to be meticulous about hemostasis,
(3) to use thrombogenic agents at the time of surgery (e.g. topical tranexamic acid, thrombin+gelfoam, etc),
(4) to close the wound with staples to allow drainage,
(5) to use a dressing with suction (see illustration below),
(5) to delay range of motion exercises until it is obvious that bleeding is under control, and
(6) to ask the patient and family to notify us promptly of increased swelling, pain or drainage.
==
To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
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How you can support research in shoulder surgery Click on this link.
We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
How you can support research in shoulder surgery Click on this link.
We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
