Trends in venous thromboembolic events and anticoagulation prescriptions for orthopaedic surgery of the shoulder

Background: There is a scarcity of literature discussing anticoagulation prescribing patterns after upper extremity orthopedic surgery. The purpose of this study is to use a large national database to identify trends in adverse events and anticoagulation prescribing following orthopedic shoulder surgery. Materials and methods: The TriNetX Research Network was used to identify all patients undergoing orthopedic shoulder surgery between January 2004 and December 2022. Patient information was stratified by year and type of surgery including arthroplasty, arthroscopy, soft tissue procedures, bony procedures, fractures, tumor resection, and amputation. Data collected included patient sex, age, race, and ethnicity. Rates of postoperative anticoagulation medications, deep vein thrombosis, and postoperative bleeding were recorded within 1 month of surgery. A subanalysis was performed comparing propensity-matched cohorts of patients with a preoperative hypercoagulable diagnosis compared with a nonhypercoagulable cohort. Statistical significance was defined as P <.05. Results: The overall rate of venous thromboembolism (VTE) and postoperative bleeding for the collective cohort was low (1.3% and 0.1%, respectively). The year with the highest rate of VTE events was 2019 (1.8%). The overall rate of patients receiving anticoagulation medication was 15.6% during the study period. The year with the highest rate for anticoagulation prescribing was 2015 for all shoulder surgery (19.2%). Patients undergoing amputation and arthroplasty procedures experienced the highest overall rates of postoperative anticoagulation prescribing (51.8 and 47.6%, respectively), whereas tumor resection and arthroscopy procedures experienced the fewest (6.2% and 6.6%, respectively). Patients with a hypercoagulable diagnosis experienced VTEs at significantly higher rates (7.0% vs. 0.9%, respectively) and received more anticoagulation medications compared with the nonhypercoagulable group (20.6% vs. 15.5%) Conclusion: The rate of VTE- and bleeding-related events for orthopedic shoulder surgeries is low. However, there is an increased rate of VTE in patients with hypercoagulability risk factors and in those undergoing arthroplasty, amputation, and fracture fixation.