VTE Risk Factors After Rotator Cuff Repair

A new study identified predictors of patients most likely to experience venous thromboembolic events (VTEs) following rotator cuff repair (RCR) surgery.

“Venous thromboembolic events (VTEs) are a major source of morbidity and mortality, with an estimated 350,000-900,000 patients per year developing a deep venous thrombus (DVT) or pulmonary embolus (PE),” the study authors wrote. “The incidence of symptomatic VTE for lower-extremity arthroplasty was found to be between 1.3% and 2.8%2, 3 and 1% and 1.8% in the setting of trauma even with prophylaxis using anticoagulation.”

Their findings were published in Arthroscopy.

The researchers conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database and used Current Procedural Terminology codes to find RCR patients treated from 2005 to 2017. The main outcomes were 30-day incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) after surgery. Patients with known VTE risk factors including age > 90 years; underwent another operation 30 days prior to RCR; had disseminated cancer; were paralyzed, mentally altered, or unresponsive > 24 hours; or had an infection at time of operation were excluded. Demographics collected included age, sex, smoking status during the year before admission, race, ethnicity, body mass index (BMI), and preoperative functional status.

A total of 39,825 RCRs were performed during the study period; 117 (0.3%) VTEs were recorded. VTE presented at a mean 11.5 days. Most (n = 31,615) RCRs were performed arthroscopically; VTE rate did not largely differ between arthroscopic (0.3%, n = 93) versus open RCR (0.3%, n = 23). Patients with an American Society of Anesthesiologists (ASA) classification of III or IV had a greater VTE risk (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.14-2.45); other risk factors included surgery >80 minutes (OR 2.10, 95% CI 1.42-3.15), performed under general anesthesia (OR 4.38, 95% CI 1.18-36.6), and in the outpatient setting (OR 6.09, 95% CI 1.06-243.7); male sex (OR 1.53, 95% CI 1.01-2.33), bleeding disorders (OR 2.87, 95% CI 1.17-7.05), or dyspnea (OR 1.51, 95% CI 1.02-2.23). Unplanned reoperation was the most significant risk factor (OR 16.6, 95% CI 5.13-53.5).

The researchers concluded that VTE after RCR is a rare complication but suggested that the risk factors be taken into consideration when treating patients.