High Altitude A Risk Factor for Venous Thromboembolism After Rotator-Cuff Repair: Presented at AAOS

By Jill Stein

SAN DIEGO -- March 20, 2017 -- High altitude is an independent risk factor for venous thromboembolism (VTE) after arthroscopic rotator cuff repair (RCR), according to results of a retrospective study presented at the 2017 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

“Although patients undergoing RCR are typically exceptionally healthy, the lower partial pressure of oxygen in the ambient air at higher altitudes in combination with the increased venous stasis and temporary hypoventilation in the early postoperative period may substantially increase the incidence of VTE in otherwise low-risk patients,” explained lead author Jourdan M. Cancienne, MD, University of Virginia Health System, Charlottesville, Virginia, speaking here at a poster presentation on March 14.

Dr. Cancienne and colleagues examined the association between the altitude of the hospital in which the procedure was performed and the incidence of VTE following arthroscopic RCR using a Medicare database that spanned the period from 2005 to 2012.

Overall, there were 6,322 high-altitude subjects, and 18,108 low-altitude control subjects.

Results showed that the rates of combined VTE (odds ratio [OR] 2.6, P < .0001), pulmonary embolism (OR 4.3, P < .0001), and lower-extremity deep vein thrombosis within 90 days (OR 2.2, P = .029) were significantly higher in patients with procedures performed at high altitude compared with matched patients with the same procedures performed at low altitude.

All patients with procedures performed at an altitude of 4,000 feet or higher were grouped into the “high altitude” study cohort. Patients with procedures performed at an altitude of 100 feet or lower formed the “low altitude” control group after being matched with patients in the high-altitude cohort by age, gender, and comorbidities.

The researchers noted that no clear recommendations exist for chemoprophylaxis following shoulder arthroscopy, and that it is important to be able to identify risk factors for the development of VTE to develop evidence-based prophylaxis strategies.

Although altitude has been cited as a risk factor for VTE in air travelers and mountaineers, procedural altitude has not been systematically evaluated as a risk factor for VTE following shoulder arthroscopy until now.

[Presentation title: High Altitude is an Independent Risk Factor for Venous Thromboembolism Following Arthroscopic Rotator Cuff Repair. Abstract P344]

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