Pitsilos C, Papadopoulos P, Givissis P, Chalidis B. Pulmonary embolism after shoulder surgery: Is it a real threat? World J Methodol 2025; 15(1): 98343 [DOI: 10.5662/wjm.v15.i1.98343]
Corresponding Author of This Article
Byron Chalidis, MD, PhD, Assistant Professor, Department of 1st Orthopaedic, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki 57010, Greece. byronchalidis@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Charalampos Pitsilos, Pericles Papadopoulos, 2nd Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54635, Greece
Panagiotis Givissis, Byron Chalidis, 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 57010, Greece
Author contributions: Pitsilos C and Chalidis B designed and performed the research, analysed the data, and wrote the paper; Givissis P and Papadopoulos P supervised the work on the paper; All authors read and approved the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with the senior author nor coauthors who contributed their efforts to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Byron Chalidis, MD, PhD, Assistant Professor, Department of 1st Orthopaedic, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki 57010, Greece. byronchalidis@gmail.com
Received: June 24, 2024 Revised: August 22, 2024 Accepted: August 29, 2024 Published online: March 20, 2025 Processing time: 96 Days and 10.5 Hours
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.
Core Tip: Pulmonary embolism is a rare and possibly fatal complication of shoulder surgery. While venous thromboembolism, which includes pulmonary embolism and deep vein thrombosis, has been extensively studied, there is a lack of data about pulmonary embolism as a distinct pathology after shoulder surgery. This review summarizes the most important information about this condition and highlights the significance of early diagnosis and treatment.
