From the Department of Orthopedic Surgery, George Washington Hospital, Washington DC (Agarwal and Stadecker), and the Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD (Agarwal, Ahmed, Miller, Best, and Srikumaran).
J Am Acad Orthop Surg. 2023 Apr 1;31(7):364-372. doi: 10.5435/JAAOS-D-22-00825. Epub 2023 Jan 19.
In 2009, the American Academy of Orthopaedic Surgeons released a consensus recommending venous thromboembolism (VTE) prophylaxis after total shoulder arthroplasty (TSA). The purpose of this study was to examine the (1) change in incidence of 90-day VTE, deep vein thrombosis (DVT), and pulmonary embolism; (2) change in utilization of chemoprophylaxis; and (3) change in the economic burden associated with VTE after TSA from 2010 to 2019.
Using the PearlDiver database, national data from 2010 to 2019 were used to identify patients who underwent primary TSA for osteoarthritis and/or rotator cuff arthropathy. Exclusions entailed liver pathology, coagulopathy, or those on prior prescribed blood thinners before TSA. Multivariable regression was used controlling for age and Charlson Comorbidity Index for all years with 2010 as the reference year.
From 2010 to 2019, there was a reduction in VTE rates from 0.89% in 2010 to 0.78% in 2019. Regarding implant type, there was no notable change in incidence of VTE, DVT, and pulmonary embolism within 90 days after anatomic TSA. Notable reductions were observed in both VTE and DVT after reverse TSA from 2010 to 2019. Prescribed chemical VTE prophylaxis utilization after TSA markedly increased from 4.41% in 2010 to 11.70% utilization in 2019. The utilization of aspirin markedly increased from 17.27% in 2010 to 65.17% in 2019. Among anticoagulants, the utilization of direct factor Xa inhibitors increased from 0.0% utilization in 2010 to 66.09% utilization in 2019. The added reimbursements associated with VTE after TSA markedly decreased from $14,122 in 2010 to $4,348 in 2019.
The incidence and economic burden associated with VTE after TSA have markedly declined following the 2010 American Academy of Orthopaedic Surgeons clinical practice guidelines. This reduction can be attributed to both an increase in VTE prevention through increased utilization of prescribed chemoprophylaxis and improvement in VTE treatment strategies.
Therapeutic, III.
2009 年，美国骨科医师学会发布了一项共识，建议在全肩关节置换术后（TSA）进行静脉血栓栓塞症（VTE）预防。本研究的目的是检查（1）90 天 VTE、深静脉血栓形成（DVT）和肺栓塞的发生率变化；（2）化学预防的使用变化；（3）2010 年至 2019 年 TSA 后与 VTE 相关的经济负担变化。
使用 PearlDiver 数据库，使用 2010 年至 2019 年的全国数据，确定接受原发性 TSA 治疗骨关节炎和/或肩袖关节炎的患者。排除有肝脏疾病、凝血功能障碍或 TSA 前服用预先规定的血液稀释剂的患者。所有年份均使用多变量回归控制年龄和 Charlson 合并症指数，以 2010 年为参考年。
2010 年至 2019 年，VTE 发生率从 0.89%降至 0.78%。关于植入物类型，解剖型 TSA 后 90 天内 VTE、DVT 和肺栓塞的发生率没有明显变化。2010 年至 2019 年，反向 TSA 后 VTE 和 DVT 的发生率均显著下降。TSA 后预防性使用化学 VTE 药物的比例从 2010 年的 4.41%显著增加到 2019 年的 11.70%。2010 年至 2019 年，阿司匹林的使用率从 17.27%显著增加至 65.17%。在抗凝剂中，直接因子 Xa 抑制剂的使用率从 2010 年的 0.0%增加到 2019 年的 66.09%。TSA 后与 VTE 相关的额外报销费用从 2010 年的 14122 美元显著下降至 2019 年的 4348 美元。
2010 年美国骨科医师学会临床实践指南发布后，TSA 后 VTE 的发生率和经济负担显著下降。这种减少归因于预防性使用化学药物的增加和 VTE 治疗策略的改进，从而增加了 VTE 的预防。
治疗性，III 级。
