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Wright FL, Schroeppel TJ, Bronsert MR, Urban S, Vega SA, Cripps MW, Dorlac WC, Jenson WR, Baker JE, McIntyre RC. Thin air, thick blood: High altitude trauma centers have increased deep venous thrombosis rates. Am J Surg 2025; 246:116365. [PMID: 40367597 DOI: 10.1016/j.amjsurg.2025.116365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Revised: 04/10/2025] [Accepted: 04/27/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND Patients undergoing elective procedures at altitudes >4000 ft have higher deep venous thrombosis (DVT) rates compared to those performed at ≤ 1000 ft. DESIGN We reviewed the American College of Surgeons Trauma Quality Improvement Program (TQIP) database from 2014 to 2019. Adults are divided into LOW (<1001 ft) or HIGH (>4000 ft) altitude treatment with DVT rates compared by multivariable regression analysis as well as using a 2:1 propensity matched model. RESULTS Risk-adjusted odds ratio (OR) for DVT at high altitude was 1.53 [95 % CI 1.42-1.64]. In patients with an Injury Severity Score (ISS) ≥ 16, the DVT rate was 1.10 % (LOW) vs 1.59 % (HIGH); risk-adjusted OR for DVT at high altitude with ISS ≥ 16 was 1.67 [1.53-1.83]. Under the propensity matched model, DVT rates at higher altitude had an OR of 1.59 [1.46-1.74]. CONCLUSION Following traumatic injury, DVT rates are increased in higher altitude treatment facilities compared to their low elevation peers.
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Affiliation(s)
- Franklin L Wright
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
| | - Thomas J Schroeppel
- Department of Surgery, University of Colorado School of Medicine, UC Health Memorial Hospital, Colorado Springs, CO, USA
| | - Michael R Bronsert
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Shane Urban
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Stephanie A Vega
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Michael W Cripps
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Warren C Dorlac
- Department of Surgery, University of Colorado School of Medicine, UC Health Medical Center of the Rockies, Loveland, CO, USA
| | - Whitney R Jenson
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer E Baker
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Robert C McIntyre
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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Pitsilos C, Papadopoulos P, Givissis P, Chalidis B. Pulmonary embolism after shoulder surgery: Is it a real threat? World J Methodol 2025; 15:98343. [PMID: 40115404 PMCID: PMC11525898 DOI: 10.5662/wjm.v15.i1.98343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/22/2024] [Accepted: 08/29/2024] [Indexed: 09/29/2024] Open
Abstract
Pulmonary embolism (PE) is a rare but devastating complication of shoulder surgery. Apart from increased morbidity and mortality rates, it may significantly impair postoperative recovery and functional outcome. Its frequency accounts for up to 5.7% of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years. It is most commonly associated with thrombophilia, diabetes mellitus, obesity, smoking, hypertension, and a history of malignancy. PE usually occurs secondary to upper or lower-extremity deep vein thrombosis (DVT). However, in rare cases, the source of the thrombi cannot be determined. Prophylaxis for PE following shoulder surgery remains a topic of debate, and the standard of care does not routinely require prophylactic medication for DVT prophylaxis. Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin, low-molecular-weight heparin, and vitamin K antagonists are indicated for high-risk patients, long-lasting operations, or concomitant severe acute respiratory syndrome coronavirus 2 infection. The most common symptoms of PE include chest pain and shortness of breath, but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia. Patients with DVT may also present with swelling and pain of the respective extremity. The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable, respectively. Hemodynamic instability may require transfer to the intensive care unit, and cardiovascular arrest can be implicated in fatal events. An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay. Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.
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Affiliation(s)
- Charalampos Pitsilos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54635, Greece
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54635, Greece
| | - Panagiotis Givissis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 57010, Greece
| | - Byron Chalidis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 57010, Greece
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Plancher KD, Schwartz EN, Mannina CM, Briggs KK, Petterson SC. High Altitude is an Independent Risk Factor for Postoperative Venous Thromboembolism Following Primary Total Knee Arthroplasty: A Large Database Study. J Arthroplasty 2024:S0883-5403(24)01325-1. [PMID: 39716508 DOI: 10.1016/j.arth.2024.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 12/17/2024] [Accepted: 12/17/2024] [Indexed: 12/25/2024] Open
Abstract
BACKGROUND High altitude may induce physiological changes that can predispose patients to venous thromboembolism (VTE), a relatively uncommon, but potentially fatal complication following total knee arthroplasty (TKA). The purpose of this study was to determine if high altitude is an independent risk factor for postoperative VTE following TKA. METHODS A large claims database was queried for patients who underwent TKA at high-altitude (≥ 1,219-meters) and low-altitude (≤ 30-meters) using Current Procedural Terminology codes, International Classification of Disease codes, and zip codes. High- and low-altitude cohorts were matched 1:3 by 5-year age range, sex, Charlson comorbidity index (CCI), diabetes mellitus, obesity (body mass index ≥ 30), hypertension, and tobacco use. There were 57,135 patients included in the high-altitude group and 171,322 in the low-altitude group. Outcome measures included 30- and 90-day incidence of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE). Chi-square was used to determine differences in demographics. Binomial logistic regression was used to determine postoperative rates of VTE, DVT, and PE. RESULTS The incidence of VTE was significantly greater in the high-altitude versus the low-altitude group at 30-days (OR [odds ratio] 1.15 [95% CI (confidence interval) 1.02 to 1.30], P = 0.022) and 90-days (OR 1.20 [95% CI 1.08 to 1.34], P = 0.0007). The incidence of DVT was significantly higher for the high-altitude cohort at both 30- (OR 1.30 [95% CI 1.10 to 1.54], P = 0.002) and 90-days (OR 1.36 [95% CI 1.18 to 1.57], P < 0.0001). The incidence of PE within 30- and 90-days was not significantly different between groups. CONCLUSIONS High altitude (> 1,219-meters) is an independent risk factor for VTE following TKA. Patients who undergo TKA at surgical centers greater than 1,219-meters in elevation are more likely to develop VTE and DVT within 30- and 90-days postoperatively. Surgeons may account for high altitude as a risk factor and determine the most suitable postoperative prophylaxis method for their patients.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York; Plancher Orthopaedics & Sports Medicine, New York, New York; Orthopaedic Foundation, Stamford, Connecticut
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Zhao ML, Lu ZJ, Yang L, Ding S, Gao F, Liu YZ, Yang XL, Li X, He SY. The cardiovascular system at high altitude: A bibliometric and visualization analysis. World J Cardiol 2024; 16:199-214. [PMID: 38690218 PMCID: PMC11056872 DOI: 10.4330/wjc.v16.i4.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND When exposed to high-altitude environments, the cardiovascular system undergoes various changes, the performance and mechanisms of which remain controversial. AIM To summarize the latest research advancements and hot research points in the cardiovascular system at high altitude by conducting a bibliometric and visualization analysis. METHODS The literature was systematically retrieved and filtered using the Web of Science Core Collection of Science Citation Index Expanded. A visualization analysis of the identified publications was conducted employing CiteSpace and VOSviewer. RESULTS A total of 1674 publications were included in the study, with an observed annual increase in the number of publications spanning from 1990 to 2022. The United States of America emerged as the predominant contributor, while Universidad Peruana Cayetano Heredia stood out as the institution with the highest publication output. Notably, Jean-Paul Richalet demonstrated the highest productivity among researchers focusing on the cardiovascular system at high altitude. Furthermore, Peter Bärtsch emerged as the author with the highest number of cited articles. Keyword analysis identified hypoxia, exercise, acclimatization, acute and chronic mountain sickness, pulmonary hypertension, metabolism, and echocardiography as the primary research hot research points and emerging directions in the study of the cardiovascular system at high altitude. CONCLUSION Over the past 32 years, research on the cardiovascular system in high-altitude regions has been steadily increasing. Future research in this field may focus on areas such as hypoxia adaptation, metabolism, and cardiopulmonary exercise. Strengthening interdisciplinary and multi-team collaborations will facilitate further exploration of the pathophysiological mechanisms underlying cardiovascular changes in high-altitude environments and provide a theoretical basis for standardized disease diagnosis and treatment.
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Affiliation(s)
- Mao-Lin Zhao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Zhong-Jie Lu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Li Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Sheng Ding
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Feng Gao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Yuan-Zhang Liu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xue-Lin Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xia Li
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Si-Yi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China.
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Momenzadeh K, Yeritsyan D, Mortensen S, Kheir N, Khak M, Caro D, Kahe F, Abbasian M, Mo C, McNichol M, Paschos N, Nazarian A. While the Incidence of Venous Thromboembolism After Shoulder Arthroscopy Is Low, the Risk Factors Are a Body Mass Index Greater than 30 and Hypertension. Arthrosc Sports Med Rehabil 2024; 6:100815. [PMID: 38149088 PMCID: PMC10749995 DOI: 10.1016/j.asmr.2023.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/20/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose This study aims to determine the overall incidence of venous thromboembolism (VTE) following shoulder arthroscopy and to define potential risk factors associated with its development that may help define guidelines for the use of thromboprophylaxis. Methods A systematic review was performed using PubMed, Embase, Web of Science, CINAHL, and Cochrane databases per PRISMA guidelines. The search terms consisted of variations of "Venous Thromboembolism" and "Shoulder Arthroscopy." Information regarding arthroscopy indication, risk factors, outcomes, and patient demographics was recorded and analyzed, and pooled odds ratios were reported for each variable. Results Six hundred eighty-five articles were identified in the initial search, and 35 articles reported DVT, PE, or VTE incidence following shoulder arthroscopy. Seventeen nonoverlapping articles with a unique patient population incidence rates. Four articles were then used for subgroup meta-analysis. The incidence rate of VTE was 0.24%, ranging from 0.01% to 5.7%. BMI >30 (OR = 1.46; 95% CI = [1.22, 1.74]; I2 = 0%) and hypertension (OR = 1.64; 95% CI = [1.03, 2.6]; I2 = 75%) were significant risk factors (P < .05) for developing VTE following shoulder arthroscopy. Diabetes (OR = 1.2; 95% CI = [0.97, 1.48]; I2 = 0%), insulin-dependent diabetes (OR = 5.58; 95% CI = [0.12, 260.19]; I2 = 85%), smoking (OR = 1.04; 95% CI = [0.79, 1.37]; I2 = 12%), male sex (OR = 0.95; 95% CI = [0.49, 1.85]; I2 = 86%) and age over 65 (OR = 4.3; 95% CI = [0.25, 72.83]; I2 = 85%) were not associated with higher VTE risk. Conclusion The VTE incidence following shoulder arthroscopy is low at 0.24%. Patients with BMI >30 and hypertension are at a higher risk for VTE after shoulder arthroscopy. Level of Evidence Level IV, systematic review and meta-analysis of Level I-IV studies.
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Affiliation(s)
- Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sharri Mortensen
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mohammad Khak
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Farima Kahe
- Cardiovascular Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Chen Mo
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Megan McNichol
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nikolaos Paschos
- Orthopaedic Surgery Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
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Marigi EM, Sperling JW, De Marinis R, Gupta P, Hassett LC, Soza F, Sanchez-Sotelo J. Venous thromboembolism following surgical management of proximal humerus fractures: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:494-498. [PMID: 37928990 PMCID: PMC10624987 DOI: 10.1016/j.xrrt.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Currently, there is limited information on the incidence of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) after surgical treatment of proximal humerus fractures (PHFs). Therefore, the purpose of this systematic review is to evaluate the incidence of VTE, DVT, and PE following surgery for PHFs. Methods A comprehensive search of several databases was performed from inception to May 27, 2022. Studies were screened and evaluated by 2 reviewers independently utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Only original, English studies that evaluated the incidences of VTE following surgical management of PHFs were included. Surgical procedures consisted of shoulder arthroplasty (SA) including both hemiarthroplasty (Hemi) and reverse shoulder arthroplasty (RSA) in addition to open reduction and internal fixation (ORIF). A pooled incidence for postoperative DVT, PE, and overall VTE was reported. Results Twelve studies met the inclusion and exclusion criteria, encompassing a total of 18,238 patients. The overall DVT, PE, and VTE rates were 0.14%, 0.59%, and 0.7%, respectively. VTE was more frequently reported after SA than ORIF, (1.27% vs. 0.53%, respectively). Among SA patients, a higher rate of DVT was seen with RSA (1.2%) with the lowest DVT rate was observed for ORIF with 0.03%. Conclusions Symptomatic VTEs following surgical treatment of PHFs, are rare, yet still relevant as a worrisome postoperative complication. Among the various procedures, VTE was the most frequently reported after SA when compared to ORIF, with RSA having the highest VTE rate.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W. Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rodrigo De Marinis
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Shoulder and Elbow Unit, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Puneet Gupta
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Francisco Soza
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
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Li T, Li Y, Zhang L, Pang L, Tang X, Zhu J. Venous thromboembolism after arthroscopic shoulder surgery: a systematic review. J Orthop Surg Res 2023; 18:103. [PMID: 36788620 PMCID: PMC9927062 DOI: 10.1186/s13018-023-03592-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To summarize the incidence, risk factors, diagnosis methods, prophylaxis methods, and treatment of venous thromboembolism (VTE) following arthroscopic shoulder surgery. METHODS Literature on VTE after arthroscopic shoulder surgeries was summarized, and all primary full-text articles reporting at least 1 case of deep vein thrombosis (DVT) or pulmonary embolism (PE) after arthroscopic shoulder surgeries were included. Articles were critically appraised and systematically analyzed to determine the incidence, risk factors, diagnosis, prophylaxis, and management of VTE following arthroscopic shoulder surgeries. RESULTS This study included 42 articles in which the incidence of VTE ranges from 0 to 5.71% and the overall incidence was 0.26%. Most VTE events took place between the operation day and the 14th day after the operation (35/51). Possible risk factors included advanced age (> 70 years), obesity (BMI ≥ 30 kg/m2), diabetes mellitus, thrombophilia, history of VTE, prolonged operation time, hormone use, and immobilization after surgery. The most common prophylaxis method was mechanical prophylaxis (13/15). No statistical difference was detected when chemoprophylaxis was applied. The management included heparinization followed by oral warfarin, warfarin alone and rivaroxaban, a direct oral anticoagulant. CONCLUSION Based on the included studies, the incidence rate of VTE after arthroscopic shoulder surgeries is relatively low. The risk factors for VTE are still unclear. CT/CTA and ultrasound were the mainstream diagnosis methods for PE and DVT, respectively. Current evidence shows that chemical prophylaxis did not deliver significant benefits, since none of the existing studies reported statistically different results. High-quality studies focusing on the prophylaxis and management of VTE population undergoing arthroscopic shoulder surgeries should be done in the future.
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Affiliation(s)
- Tao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Yinghao Li
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Linmin Zhang
- grid.13291.380000 0001 0807 1581West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Long Pang
- grid.13291.380000 0001 0807 1581Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Nursing, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, Sichuan Province, People's Republic of China.
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Triplet JJ, Schuette HB, Cheema AN, Marigi EM, Hassett LC, Barlow JD, Camp CL, Morrey ME, Sperling JW, Sanchez-Sotelo J. Venothromboembolism following shoulder arthroscopy: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:464-468. [PMID: 37588470 PMCID: PMC10426627 DOI: 10.1016/j.xrrt.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Venous thromboembolic events (VTEs) following orthopedic surgery may lead to serious morbidity and mortality. Fortunately, VTEs following upper extremity procedures are uncommon. However, the true incidence is likely underreported. The aim of this study is to provide a systematic review, excluding large database studies, to report on the incidence of VTEs following shoulder arthroscopic procedures. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review of multiple databases was performed. A comprehensive search of several databases from inception to September 1, 2021, limited to English language and excluding animal studies, was designed and conducted. Studies were screened by 2 independent reviewers. A decision to exclude studies from large surgical or insurance claim databases was made to minimize the risk of including overlapping data points in this systematic review. Results Thirteen studies met inclusion and exclusion criteria and form part of this systematic review. A total of 32,407 patients were included in this study. Among these patients, the deep vein thrombosis, pulmonary embolism, and overall VTE rates were 0.15%, 0.08%, and 0.21%, respectively. Among the patients specified to have undergone arthroscopic rotator cuff repair, the rate of deep vein thrombosis, pulmonary embolism, and overall VTE was 0.71%, 0.37%, and 1.04%, respectively. Conclusion While symptomatic VTEs are rare following shoulder arthroscopic procedures, surgeons must be aware that they still account for a certain number of postoperative complications. Factors such as operative time, open procedures, obesity, and altitude may increase the risk of postoperative VTE although conflicting data exist. Current literature supports the idea that chemical antithrombotic prophylaxis likely provides no significant advantage over early mobilization in reducing VTEs following shoulder arthroscopy in low-risk patients.
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Yang H, Yang G, Xu M, Zhao Y, He S, Wang Q, Wen Y, Huang C, Wu J, Ren C, Yang Y, He S. Impact of high altitude on the incidence of postoperative venous thromboembolism and its genetic susceptibility: A meta-analysis and systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156632. [PMID: 35691358 DOI: 10.1016/j.scitotenv.2022.156632] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The effect of high-altitude (HA) on venous thromboembolism (VTE) and its mechanism remains ambiguous. To clarify this, we aimed to conduct a meta-analysis and systematic review to evaluate the incidence of VTE at HA and comparatively low altitude (LA) and figure out the intrinsic risk factors such as susceptibility genes of patients with VTE at HA. METHODS We selected studies that explored the risk factors for HA and VTE by searching PubMed, Embase, and Web of Science to analyze the impact of HA on VTE. All relevant studies before August 2021 were screened using the terms ([high altitude] OR [plateau] OR [mountain]) AND ([venous thromboembolism] OR [deep vein thrombosis] OR [pulmonary embolism]). Latest studies on the gene of HA-VTE patients were also summarized and analyzed. RESULTS Fifteen studies were eventually assessed, and the overall numbers of subjects with and without VTE were 1475 and 286,926 respectively. The overall incidence of VTE, deep vein thrombosis (DVT) and pulmonary embolism (PE) in the HA group was significantly higher than that in the LA group (P < 0.01). The overall incidence of VTE, DVT and PE in the HA group was significantly higher than that in the LA group at 30 days post operation (P < 0.05, P < 0.05 and P < 0.01, respectively). At 90 days post operation, incidence of VTE and PE in the HA group was higher than that in the LA group (P < 0.01and P < 0.01, respectively), but there was no difference in the incidence of DVT (P = 0.07). Regarding endogenous factors, the analysis of genes in patients with HA-VTE revealed numerous targeted genes such as ANG, ACE, lncRNA-LINC00 659/UXT-AS1 and GP4. CONCLUSIONS We observed a significant association between HA and the overall incidence of VTE and that at 30/90 days post operation, indicating that HA may be a risk factor for VTE.
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Affiliation(s)
- Haihong Yang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Guan Yang
- Department of Pain, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Meiling Xu
- Department of Geriatrics, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Yuanyuan Zhao
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Shengdong He
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Qiwu Wang
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Yi Wen
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Chen Huang
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Jianping Wu
- Department of Neurosurgery, The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Chao Ren
- The General Hospital of Western Theater Command, Chengdu 610083, China
| | - Yongxiang Yang
- Department of Neurosurgery, The General Hospital of Western Theater Command, Chengdu 610083, China.
| | - Siyi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Chengdu 610083, China.
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Zhong X, Ye Z, Zhou X, Jiang R, Jia Y, Du W, Yang H, Zhang L, Lu B, Zong Z. Time Course of Coagulo-Fibrinolytic Derangements During Acclimatization to High Altitude in Rabbits and a Preliminary Study on the Possible Mechanisms. High Alt Med Biol 2022; 23:240-248. [PMID: 35544291 DOI: 10.1089/ham.2021.0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Zhong, Xin, Zhao Ye, Xiaolin Zhou, Renqing Jiang, Yijun Jia, Wenqiong Du, Haoyang Yang, Lin Zhang, Bai Lu, and Zhaowen Zong. Time course of coagulo-fibrinolytic derangements during acclimatization to high altitude in rabbits and a preliminary study on the possible mechanisms. High Alt Med Biol. 00:000-000, 2022. Background: Conflicting data exist regarding changes in the coagulation system during acclimatization to high altitude (HA), which makes the prevention of thromboembolic events difficult. The present study aimed at observing the dynamic changes in the coagulo-fibrinolysis system during acclimatization to HA and at exploring the possible mechanisms. Materials and Methods: Twenty rabbits of both sexes were randomly divided into two groups, including group A rabbits (healthy plain controls) and group B rabbits (acutely exposed to HA). A traditional coagulation test, thromboelastography analysis, and full blood cell count were used to assess the coagulo-fibrinolytic changes at different time points. Plasma was collected to examine the levels of relevant biomarkers. Results: Six hours and 1 day after acute exposure to HA, the coagulo-fibrinolytic system demonstrated a hypercoagulable state. Further, 3 days after exposure to HA, group B rabbits showed hypocoagulability, increased fibrinolysis, and lower clot firmness and 7 days after exposure to HA, delayed coagulation, decreased fibrinolysis, and increased clot firmness were observed. Subsequently, 14, 21, and 28 days after exposure to HA, we found increased clot firmness. Increased platelet counts and concentrations of fibrinogen and plasminogen activator inhibitor-1 contributed to this change. Conclusion: The coagulo-fibrinolytic derangements during acclimatization to HA in rabbits demonstrated a dynamic pattern.
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Affiliation(s)
- Xin Zhong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China
| | - Zhao Ye
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China.,Department of Orthopedics, XinQiao Hospital, Army Medical University, Chongqing, China
| | - Xiaolin Zhou
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China
| | - Renqing Jiang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China
| | - Yijun Jia
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China
| | - Wenqiong Du
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China
| | - Haoyang Yang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China
| | - Lin Zhang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China
| | - Bai Lu
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China
| | - Zhaowen Zong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, China.,Department of Orthopedics, XinQiao Hospital, Army Medical University, Chongqing, China
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11
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Jones CA, Broggi MS, Holmes JS, Gerlach EB, Goedderz CJ, Ibnamasud SH, Hernandez-Irizarry R, Schenker ML. High Altitude as a Risk Factor for Venous Thromboembolism in Tibial Plateau Fractures. Cureus 2022; 14:e24388. [PMID: 35637832 PMCID: PMC9132220 DOI: 10.7759/cureus.24388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Tibial plateau fractures are often significant injuries that can require complex surgical interventions with prolonged perioperative immobilization, thereby increasing the risk of developing venous thromboembolic (VTE) events, specifically, deep vein thrombosis (DVT) and pulmonary embolism (PE). Risk stratification is paramount for guiding VTE prophylaxis. Although high altitude has been suggested to create a prothrombotic state, virtually no studies have explored its clinical effects in lower extremity trauma. The purpose of this study was to compare surgical fixation of tibial plateau fractures at high and low altitudes and its effects on post-operative VTE development. Methods: The Truven MarketScan claims database was used to retrospectively identify patients who underwent surgical fixation of isolated and closed tibial plateau fractures using Current Procedural Terminology (CPT) codes over a 10-year period. Extraneous injuries were excluded using the International Classification of Diseases, 10th edition (ICD-10), and CPT codes. Patient demographics, comorbidities, and DVT chemoprophylaxis prescriptions were obtained. Patients were partitioned into high altitude (>4000 feet) or low altitude (<100 feet) cohorts based on the zip codes of their surgery locations. One-to-one matching and univariate analysis were used to assess and control any baseline discrepancies between cohorts; multivariate regression was then performed between cohorts to determine the odds ratios (OR) for developing VTEs post-operatively. Results: There were 7,832 patients included for analysis. There was no statistical difference between high and low altitude cohorts in developing VTEs within 30 days post-operatively. Higher altitudes were associated with increased odds of developing DVT (OR 1.21, p = 0.043) and PE (OR 1.27, p = 0.037) within 90 days post-operatively. Conclusions: Surgical fixation of tibial plateau fractures is associated with an increased risk of developing VTEs at high altitudes within 90 days post-operatively. Understanding such risk factors in specific orthopaedic patient populations is essential for optimizing DVT prophylaxis protocols. Further studies should investigate this relationship and the role of DVT prophylaxis regimens in this population.
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12
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13
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Incidence and Prevention of Thromboembolic Complications for Sports and Arthroscopic-related Surgery: Evidence-based Recommendations. Sports Med Arthrosc Rev 2022; 30:24-28. [PMID: 35113839 DOI: 10.1097/jsa.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of thromboembolic events following arthroscopic surgery is relatively rare. Despite this, these are important complications to be aware of, as arthroscopic procedures are performed in high frequency each year and can lead to a substantial burden within health care. Over the past several decades, pharmacologic antithrombotic prevention strategies following knee arthroscopy have been extensively studied; however, their efficacy remains controversial, and there is a lack of consensus regarding a standard prevention protocol, with the exception of the established benefits of early mobilization. Several surgical and medical risk factors have been established and are important to consider as they specifically relate to each individual patient's risk of thromboembolic disease. Based on the best available evidence, chemical thromboprophylaxis appears to be unnecessary among healthy patients but may be beneficial for higher risk patients, especially those with a prior history of venous thromboembolism. A standard screening tool for risk factors in arthroscopy patients may be a cost-effective and safe solution for implementing preventative efforts.
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14
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Abstract
Orthopedic sports surgery of the knee and shoulder is generally considered to be safe and effective. Vascular complications can occur during or after arthroscopy of either joint. A thorough understanding of anatomy, particularly when placing portals in non-routine locations, is extremely important. Prompt recognition of any vascular complication is of significant importance. This review will discuss the potential vascular complications for both knee and shoulder sports surgery, review the relevant anatomy, and discuss the treatment and expected outcome of each.
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15
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Mancini MR, LeVasseur MR, Hawthorne BC, Marrero DE, Mazzocca AD. Venous thromboembolism complications in shoulder surgery: current concepts. J ISAKOS 2021; 6:283-289. [PMID: 34535553 DOI: 10.1136/jisakos-2020-000538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 11/04/2022]
Abstract
Venous thromboembolism (VTE) is a rare yet known complication of shoulder surgery. Concerning shoulder arthroplasty, reported rates of VTE range from 0.2% to 16%. Unlike many lower extremity procedures, particularly total hip and knee arthroplasty, chemical prophylactic guidelines for VTE in shoulder surgeries have not been established. Some argue that doing so is unnecessary. On the contrary, mechanical prophylaxis is nearly universally accepted in shoulder surgery, particularly for more lengthy procedures. With limited VTE incidence in shoulder surgery, treatment is anecdotally derived from the hip and knee arthroplasty literature. Recent studies have successfully identified risk factors for VTE related to the patient and to the surgery itself. Awareness of these risk factors by the surgeon and declaration of these factors to the patient should be discussed as part of the informed consent process. Further investigational studies and larger patient cohorts will be necessary to optimise VTE prevention in shoulder surgeries.
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Affiliation(s)
- Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Benjamin C Hawthorne
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Daniel E Marrero
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
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16
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Mikołajczak K, Czerwińska K, Pilecki W, Poręba R, Gać P, Poręba M. The Impact of Temporary Stay at High Altitude on the Circulatory System. J Clin Med 2021; 10:1622. [PMID: 33921196 PMCID: PMC8068881 DOI: 10.3390/jcm10081622] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
In recent times many people stay temporarily at high altitudes. It is mainly associated with the growing popularity of regular air travel, as well as temporary trips to mountain regions. Variable environmental conditions, including pressure and temperature changes, have an impact on the human body. This paper analyses the physiological changes that may occur while staying at high altitude in healthy people and in people with cardiovascular diseases, such as arterial hypertension, pulmonary hypertension, heart failure, ischemic heart disease, or arrhythmias. Possible unfavourable changes were underlined. Currently recognized treatment recommendations or possible treatment modifications for patients planning to stay at high altitudes were also discussed.
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Affiliation(s)
- Karolina Mikołajczak
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, PL 50-368 Wroclaw, Poland; (K.M.); (W.P.); (M.P.)
| | - Karolina Czerwińska
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland;
| | - Witold Pilecki
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, PL 50-368 Wroclaw, Poland; (K.M.); (W.P.); (M.P.)
| | - Rafał Poręba
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland;
| | - Paweł Gać
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland;
| | - Małgorzata Poręba
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, PL 50-368 Wroclaw, Poland; (K.M.); (W.P.); (M.P.)
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17
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Ji L, Lyu CL, Feng M, Qiang H. Asymptomatic Pulmonary Embolism After Shoulder Arthroscopy: Case Report and Literature Review. Orthop Surg 2021; 13:1119-1125. [PMID: 33719207 PMCID: PMC8126936 DOI: 10.1111/os.12982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is extremely rare after shoulder arthroscopy. However, early identification of the situation deserves attention due to its potential risk of causing death. By now, it is still difficult to detect the PE without symptoms and clear sources during the perioperative period. CASE PRESENTATION We report here two cases of asymptomatic PE, both happening within 24 h after shoulder arthroscopy, without any detected deep venous thrombosis of extremities. It is suspected the cases were due to the abnormal decrease in partial pressures of oxygen and arterial oxygen saturation, and were confirmed by computed tomography pulmonary angiography. We also discuss the reason why the patients showed no related symptoms when PE occurred and perform a review of PE following shoulder arthroscopy. CONCLUSIONS This report highlights that PE could occur in the early phase after shoulder arthroscopy. An unexplained decrease in partial pressure of oxygen or arterial oxygen saturation should be considered seriously. The symptoms of PE might be masked due to patients' tolerance to hypoxia.
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Affiliation(s)
- Le Ji
- Department of Orthopaedic Surgery, The Third Affiliated Hospital of Xi'an Jiaotong University (Shaanxi Provincial People's Hospital), Xi'an, China
| | - Chang-Lei Lyu
- Division of Computed Tomography, The Third Affiliated Hospital of Xi'an Jiaotong University (Shaanxi Provincial People's Hospital), Xi'an, China
| | - Min Feng
- Department of Orthopaedic Surgery, The Third Affiliated Hospital of Xi'an Jiaotong University (Shaanxi Provincial People's Hospital), Xi'an, China
| | - Hui Qiang
- Department of Orthopaedic Surgery, The Third Affiliated Hospital of Xi'an Jiaotong University (Shaanxi Provincial People's Hospital), Xi'an, China
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18
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Garrido D, Garrido S, González M, Pullas G. Letter to the Editor: Pulmonary Embolism Mortality in the Elderly Population Living at High Altitude in Ecuador. High Alt Med Biol 2020; 22:110-112. [PMID: 33047979 DOI: 10.1089/ham.2020.0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David Garrido
- Posgrado de Hematología, Universidad de la Republica, Montevideo, Uruguay
| | - Santiago Garrido
- Unidad de Cuidados Intensivos, Hospital General del IESS, Ibarra, Ecuador
| | | | - Gonzalo Pullas
- Servicio de Cirugía Vascular y Angiología, Hospital de Especialidades de las Fuerzas Armadas N°1, Quito, Ecuador
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19
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Venous thrombosis at altitude presents with distinct biochemical profiles: a comparative study from the Himalayas to the plains. Blood Adv 2020; 3:3713-3723. [PMID: 31765479 DOI: 10.1182/bloodadvances.2018024554] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/22/2019] [Indexed: 11/20/2022] Open
Abstract
High-altitude (HA) hypoxia exposure is believed to induce venous thromboembolism (VTE) in otherwise healthy individuals, although this needs to be fully established. The present study aims to ascertain the role of HA exposure in aggravating any predisposition toward VTE and to explore whether the etiology of HA-induced VTE is different from that of VTE closer to sea level. We compared manifestation-matched male VTE patients from HA (HAPs) and VTE patients from the plains closer to sea level (SLPs) for 54 parameters, including coagulation-related, fibrinolytic, and thrombophilic variables, as well as markers for stress and inflammatory response and platelet and endothelial activation. Our results established an association between HA hypoxia and VTE in alterations of primarily hemostatic variables. Approximately 96% of HAPs presented with ≥10 altered parameters out of 54 studied compared with 7% of SLPs. Elevated platelet count, von Willebrand factor, and clotting factors and altered coagulation exhibited significant associations with VTE events and altitude exposure (all P < .05). Additionally, most VTEs at HA were associated with younger age groups, unlike those on the plains. A receiver operator characteristic curve analysis revealed differences between HAPs and SLPs for CD40 ligand (area under the curve [AUC], 0.90; 95% confidence interval [CI], 0.84-0.96]), P-selectin (0.79; 0.70-0.88), platelet factor-4 (0.90; 0.84-0.96), intracellular adhesion molecule-1 (0.86; 0.79-0.93), vascular cell adhesion molecule-1 (0.97; 0.95-0.99), vascular endothelial growth factor (0.87; 0.8-0.94), FLT4 (0.94; 0.89-0.99), and Toll-like receptor-2 (0.98; 0.96-1.0) (all P < .05). In conclusion, this study suggests that HA exposure perturbs the molecules associated with vascular integrity and contributes to the early onset of VTE.
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20
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Targeted gene expression study using TaqMan low density array to gain insights into venous thrombo-embolism (VTE) pathogenesis at high altitude. Blood Cells Mol Dis 2020; 82:102421. [PMID: 32171843 DOI: 10.1016/j.bcmd.2020.102421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022]
Abstract
Venous thrombo-embolism (VTE) is multi-factorial disease involving several genetic and acquired risk factors responsible for its onset. It may occur spontaneously upon climbing at High Altitude (HA). Several studies demonstrated that hypoxic conditions prevailing at HA pose an independent risk factor for VTE; however, molecular mechanism remains unknown. Present study aims to identify genes associated with HA-induced VTE pathophysiology using real time TaqMan Low-Density Array (TLDA) of known candidate genes. Gene expression of total 93 genes were studied and analyzed in patients of VTE from HA (HA-VTE) and from sea level (SL-VTE) in comparison to respective controls. Both HA-VTE and SL-VTE patients showed up-regulation of 37 genes involved in blood coagulation cascade, clot formation, platelet formation, endothelial response, angiogenesis, cell adhesion and calcium channel activity. Seven genes including ACE, EREG, C8A, DLG2, USF1, F2 and PCDHA7 were up-regulated in both HA-controls and VTE patients (both HA-VTE and SL-VTE) indicating their role during VTE event and also upon HA exposure. Ten genes; CDH18, FGA, EDNBR, GATA2, MAPK9, BCAR1, FRK, F11, PCDHA1 and ST8SIA4 were uniquely up-regulated in HA-VTE. The differentially expressed genes from the present study could be determining factors for HA-VTE susceptibility and provide insights into VTE occurrence at HA.
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21
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Srivastava S, Garg I, Kumari B, Rai C, Singh Y, Kumar V, Yanamandra U, Singh J, Bansal A, Kumar B. Diagnostic potential of circulating micro RNA hsa-miR-320 in patients of high altitude induced deep vein thrombosis: An Indian study. GENE REPORTS 2019. [DOI: 10.1016/j.genrep.2019.100550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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22
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Donnally CJ, Vakharia AM, Sheu JI, Vakharia RM, Damodar D, Shenoy K, Gjolaj JP. High Altitude Is an Independent Risk Factor for Developing a Pulmonary Embolism, but Not a Deep Vein Thrombosis Following a 1- to 2-Level Lumbar Fusion. Global Spine J 2019; 9:729-734. [PMID: 31552154 PMCID: PMC6745647 DOI: 10.1177/2192568219828349] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To identify if a 1- to 2-level posterior lumbar fusion at higher altitude is an independent risk factor for postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE). METHODS A national Medicare database was queried for all patients undergoing 1- to 2-level lumbar fusions from 2005 to 2014. Those with a prior history of DVT, PE, coagulopathy, or peripheral vascular complications were excluded to better isolate altitude as the dependent variable. The groups were matched 1:1 based on age, gender, and comorbidities to limit potential cofounders. Using ZIP codes of the hospitals where the procedure occurred, we separated our patients into high (>4000 feet) and low (<100 feet) altitudes to investigate postoperative rates of DVTs and PEs at 90 days. RESULTS Compared with lumbar fusions performed at low-altitude centers, patients undergoing the same procedure at high altitude had significantly higher PE rates (P = .010) at 90 days postoperatively, and similar rates of 90-day postoperative DVTs (P = .078). There were no significant differences in age or comorbidities between these cohorts due to our strict matching process (P = 1.00). CONCLUSION Spinal fusions performed at altitudes >4000 feet incurred higher PE rates in the first 90 days compared with patients receiving the same surgery at <100 feet but did not incur higher rates of postoperative DVTs.
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Affiliation(s)
- Chester J. Donnally
- University of Miami Hospital, Miami, FL, USA,Chester J. Donnally III, Department of
Orthopaedics, University of Miami Hospital, 1400 NW 12th Avenue, Miami, FL
33136, USA.
| | | | - Jonathan I. Sheu
- University of Miami Leonard M. Miller School of Medicine, Miami, FL,
USA
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23
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Abstract
Venous thromboembolism (VTE) in the orthopaedic literature largely focuses on lower extremity trauma and arthroplasty, with relatively few investigations of VTE after shoulder surgery. Because the rate of shoulder surgery, especially arthroplasty, continues to expand, it is important for practicing surgeons to understand the magnitude of risk, potential consequences, and prevention methods with regard to VTE. VTE after shoulder surgery has been a topic of increasing interest over the past decade, and the purpose of this review is to examine the recent literature on pathophysiology, risk factors, incidence, diagnosis, sequelae, prevention, treatment, and current recommendations regarding VTE after shoulder surgery.
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24
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Du X, Zhang R, Ye S, Liu F, Jiang P, Yu X, Xu J, Ma L, Cao H, Shen Y, Lin F, Wang Z, Li C. Alterations of Human Plasma Proteome Profile on Adaptation to High-Altitude Hypobaric Hypoxia. J Proteome Res 2019; 18:2021-2031. [PMID: 30908922 DOI: 10.1021/acs.jproteome.8b00911] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
For individuals migrating to or residing permanently in high-altitude regions, environmental hypobaric hypoxia is a primary challenge that induces several physiological or pathological responses. It is well documented that human beings adapt to hypobaric hypoxia via some protective mechanisms, such as erythropoiesis and overproduction of hemoglobin; however, little is known on the alterations of plasma proteome profiles in accommodation to high-altitude hypobaric hypoxia. In the present study, we investigated differential plasma proteomes of high altitude natives and lowland normal controls by a TMT-based proteomic approach. A total of 818 proteins were identified, of which 137 were differentially altered. Bioinformatics (including GO, KEGG, protein-protein interactions, etc.) analysis showed that the differentially altered proteins were basically involved in complement and coagulation cascades, antioxidative stress, and glycolysis. Validation results demonstrated that CCL18, C9, PF4, MPO, and S100A9 were notably up-regulated, and HRG and F11 were down-regulated in high altitude natives, which were consistent with TMT-based proteomic results. Our findings highlight the contributions of complement and coagulation cascades, antioxidative stress, and glycolysis in acclimatization to hypobaric hypoxia and provide a foundation for developing potential diagnostic or/and therapeutic biomarkers for high altitude hypobaric hypoxia-induced diseases.
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Affiliation(s)
- Xi Du
- Institute of Blood Transfusion , Chinese Academy of Medical Sciences & Peking Union Medical College , Chengdu 610052 , China
| | - Rong Zhang
- Institute of Blood Transfusion , Chinese Academy of Medical Sciences & Peking Union Medical College , Chengdu 610052 , China
| | - Shengliang Ye
- Institute of Blood Transfusion , Chinese Academy of Medical Sciences & Peking Union Medical College , Chengdu 610052 , China
| | - Fengjuan Liu
- Institute of Blood Transfusion , Chinese Academy of Medical Sciences & Peking Union Medical College , Chengdu 610052 , China
| | - Peng Jiang
- Institute of Blood Transfusion , Chinese Academy of Medical Sciences & Peking Union Medical College , Chengdu 610052 , China
| | - Xiaochuan Yu
- Department of Transfusion , Aba Prefecture People's Hospital , Ngawa Tibetan and Qiang Autonomous Prefecture 510530 , China
| | - Jin Xu
- Department of Chemistry , University of Massachusetts , Lowell , Massachusetts 01854 , United States
| | - Li Ma
- Institute of Blood Transfusion , Chinese Academy of Medical Sciences & Peking Union Medical College , Chengdu 610052 , China
| | - Haijun Cao
- Institute of Blood Transfusion , Chinese Academy of Medical Sciences & Peking Union Medical College , Chengdu 610052 , China
| | - Yuanzhen Shen
- Department of Transfusion , Aba Prefecture People's Hospital , Ngawa Tibetan and Qiang Autonomous Prefecture 510530 , China
| | - Fangzhao Lin
- Institute of Blood Transfusion , Chinese Academy of Medical Sciences & Peking Union Medical College , Chengdu 610052 , China
| | - Zongkui Wang
- Institute of Blood Transfusion , Chinese Academy of Medical Sciences & Peking Union Medical College , Chengdu 610052 , China.,Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base , Chengdu 610052 , China
| | - Changqing Li
- Institute of Blood Transfusion , Chinese Academy of Medical Sciences & Peking Union Medical College , Chengdu 610052 , China.,Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base , Chengdu 610052 , China
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25
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Stone AV, Agarwalla A, Gowd AK, Jacobs CA, Macalena JA, Lesniak BP, Verma NN, Romeo AA, Forsythe B. Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery. Orthop J Sports Med 2019; 7:2325967118822970. [PMID: 30729148 PMCID: PMC6350148 DOI: 10.1177/2325967118822970] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis. PURPOSE To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking OCPs. A matched group was subsequently created to evaluate the incidence of VTE in similar patients with and without OCP use. RESULTS A total of 57,727 patients underwent arthroscopic shoulder surgery from 2007 to 2016, and 26,365 patients (45.7%) were female. At the time of surgery, 924 female patients (3.5%) were taking OCPs. The incidence of vascular thrombosis was 0.57% (n = 328) after arthroscopic shoulder surgery, and there was no significant difference in the rate of vascular thrombosis in male or female patients (0.57% vs 0.57%, respectively; P > .99). The incidence of VTE in female patients taking and not taking OCPs was 0.22% and 0.57%, respectively (P = .2). In a matched-group analysis, no significant difference existed in VTE incidence between patients with versus without OCP use (0.22% vs 0.56%, respectively; P = .2). On multivariate analysis, hypertension (odds ratio [OR], 2.00; P < .001) and obesity (OR, 1.43; P = .002) were risk factors for VTE. CONCLUSION OCP use at the time of arthroscopic shoulder surgery is not associated with an increased risk of VTE. Obesity and hypertension are associated with a greater risk for thrombolic events, although the risk remains very low. Our findings suggest that patients taking OCPs should be managed according to the surgeon's standard prophylaxis protocol for arthroscopic shoulder surgery.
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Affiliation(s)
- Austin V. Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of
Kentucky, Lexington, Kentucky, USA
| | - Avinesh Agarwalla
- Midwest Orthopaedics at Rush, Rush University Medical Center,
Chicago, Illinois, USA
| | - Anirudh K. Gowd
- Midwest Orthopaedics at Rush, Rush University Medical Center,
Chicago, Illinois, USA
| | - Cale A. Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, University of
Kentucky, Lexington, Kentucky, USA
| | - Jeffrey A. Macalena
- Department of Orthopaedic Surgery, University of Minnesota,
Minneapolis, Minnesota, USA
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh,
Pittsburgh, Pennsylvania, USA
| | - Nikhil N. Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center,
Chicago, Illinois, USA
| | - Anthony A. Romeo
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia,
Pennsylvania, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center,
Chicago, Illinois, USA
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Damodar D, Vakharia R, Vakharia A, Sheu J, Donnally CJ, Levy JC, Kaplan L, Munoz J. A higher altitude is an independent risk factor for venous thromboembolisms following total shoulder arthroplasty. J Orthop 2018; 15:1017-1021. [PMID: 30377388 DOI: 10.1016/j.jor.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/30/2018] [Indexed: 01/24/2023] Open
Abstract
Introduction High altitudes lead to physiological changes that may predispose to venous thromboembolisms (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE). No prior study has evaluated if there is also a higher risk of VTEs after total shoulder arthroplasties (TSAs) performed at higher elevations compared to lower elevations. The purpose of this study was to identify if undergoing TSA at a higher altitude center (>4000 feet above sea level) is an independent risk factor for a postoperative VTE. Methods A retrospective review was performed from 2005 to 2014 using the Medicare Standard Analytical Files of the Pearl Diver database (Pearl Diver Technologies, West Conshohocken, PA, USA). The inclusion criteria for the study group consisted of all patients in the database undergoing primary TSAs at an altitude above 4000 feet. Patients were queried using the International Classification of Disease 9th revision codes (ICD-9). All patients undergoing primary TSA were queried using ICD-9 procedure code 81.80. Patients were filtered using the zip codes of the hospitals where the procedure occurred and were separated into high (>4,000 ft) and low (<100 ft) altitudes. Patients undergoing TSA in altitudes <100 ft represented the control group. Patients with a history of VTE, DVT, PE, and coagulation disorders were excluded from the study. Patients in the study group were randomly matched 1:1 according to age, gender, and comorbidities. Two mutually exclusive cohorts were formed and rates of VTE, DVT, and PE were analyzed and compared. Statistical analysis was performed using the programming language R (University of Auckland, New Zealand). An alpha value less than 0.05 was considered statistically significant. Results In the first 30 postoperative days, patients undergoing TSA at a higher altitude experienced a significantly higher rate of PEs (odds ratio [OR], 39.5; P = <0.001) when compared to similar patients at lower altitudes. This trend was also present for PE (OR, 2.02; P < 0.03) at 90 days postoperatively. Conclusion TSAs performed at higher altitudes (>4000 feet) have a higher rate of acute postoperative PEs in the first 30 days and 90 days postoperatively when compared to matched patients receiving the same surgery at a lower altitude (<100 feet). TSA patients at high altitude should be counseled on these increased risks.
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Affiliation(s)
- Dhanur Damodar
- University of Miami Hospital, Department of Orthopedic Surgery, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
| | - Rushabh Vakharia
- Holy Cross Hospital, Orthopedic Research Institute, 5597 North Dixie Highway, Ft. Lauderdale, FL, 33308, USA
| | - Ajit Vakharia
- Morehouse School of Medicine, 720 Westview Dr., 30310, Atlanta, GA, USA
| | - Jon Sheu
- University of Miami Hospital, Department of Orthopedic Surgery, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
| | - Chester J Donnally
- University of Miami Hospital, Department of Orthopedic Surgery, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
| | - Jonathan C Levy
- Holy Cross Hospital, Orthopedic Research Institute, 5597 North Dixie Highway, Ft. Lauderdale, FL, 33308, USA
| | - Lee Kaplan
- University of Miami Hospital, Department of Orthopedic Surgery, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
| | - Julianne Munoz
- University of Miami Hospital, Department of Orthopedic Surgery, 1400 N.W. 12th Ave, Miami, FL, 33136, USA
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Damodar D, Donnally CJ, Sheu JI, Law TY, Roche MW, Hernandez VH. A Higher Altitude Is an Independent Risk Factor for Venous Thromboembolisms After Total Hip Arthroplasty. J Arthroplasty 2018; 33:2627-2630. [PMID: 29691178 DOI: 10.1016/j.arth.2018.03.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/22/2018] [Accepted: 03/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND High altitudes lead to physiological changes that may predispose to venous thromboembolisms (VTEs) including deep vein thrombosis and pulmonary embolism (PE). No prior study has evaluated if there is also a higher risk of VTEs for total hip arthroplasties (THAs) performed at higher elevations. The purpose of this retrospective study was to identify if undergoing THA at a higher altitude center (>4000 feet above sea level) is an independent risk factor for a postoperative VTE. METHODS A thorough evaluation of the Pearl Diver Database was performed for patients undergoing THAs from 2005 to 2014. Using International Classification of Diseases Ninth Edition facilitated in ascertaining patients who underwent THA. Using the ZIP codes of the hospitals where the procedure occurred, we separated our groups into high-altitude (>4000 ft) and low-altitude (<100 ft) groups. RESULTS In the first 30 postoperative days, patients undergoing THA at a higher altitude experienced a significantly higher rate of PEs (odds ratio, 1.74; P = .003) when compared to similar patients at lower altitudes. This trend was also present for PE (odds ratio, 1.59; P < .001) at 90 days postoperatively. CONCLUSION THAs performed at higher altitudes (>4000 feet) have a higher rate of acute postoperative PEs in the first 30 days and also 90 days postoperatively when compared to matched patients receiving the same surgery at a lower altitude (<100 feet). THA patients at high altitude should be counseled on these increased risks; however, owing to retrospective nature and confounders, prospective studies are necessary to explore this outcome in more detail.
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Affiliation(s)
- Dhanur Damodar
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
| | - Chester J Donnally
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
| | - Jonathan I Sheu
- Department of Education, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Tsun Y Law
- Department of Orthopedic Surgery, Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, Florida
| | - Martin W Roche
- Department of Orthopedic Surgery, Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, Florida
| | - Victor H Hernandez
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
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Desai VS, Southam BR, Grawe B. Complications Following Arthroscopic Rotator Cuff Repair and Reconstruction. JBJS Rev 2018; 6:e5. [DOI: 10.2106/jbjs.rvw.17.00052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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