Orthopaedic and Traumatology, Hospital Clínic Barcelona, Barcelona, Spain

Purpose: To evaluate the evidence based thromboembolic risk in major shoulder surgery, in order to suggest or not the convenience to prescribe deep venous thrombosis (DVT) prophylaxis in the setting of our current practice as shoulder surgeons.

Material and Methods: A systematic literature search in the Pub Med and Medline databases related to thromboembolic complications after shoulder surgery was performed. Moreover, an overview of the current guidelines of DVT prophylaxis in orthopedic surgery was also done in order to find any recommendation that we could apply to this groupspecific population.

Results: We have not found in orthopedic guidelines any specific recommendation about performing or not DVT prophylaxis in shoulder surgery. Nevertheless, thromboembolic risk factors, individual and/or associated to surgery, are well defined and could be applied to this surgery. Several case-reports of fatal pulmonary embolism after shoulder surgery, including arthroscopy, have been published in the medical literature. Moreover, a few retrospective reviews and one prospective study shows a not inconsiderable amount of DVT episodes after shoulder surgery, particularly arthroplasties, almost comparable to major lower limb surgery.

Conclusion: Despite the fact that limited evidence is available, the risk of DVT after shoulder surgery probably has been underestimated. On the basis of the data published and the very frequent association of thromboembolic risk factors in patients undergoing joint replacement or major shoulder surgery for fractures, we suggest that this population must be considered for routine DVT prophylaxis. Screening for risk factors of DVT should be done previously to any shoulder surgery, including arthroscopic procedures, in order to prevent thromboembolic complications.