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Background: There is a paucity of literature discussing anticoagulation prescribing patterns after upper extremity orthopedic surgery. The purpose of this study is to use a large national database to identify trends in adverse events and anticoagulation prescribing following orthopedic shoulder surgery., Materials and Methods: The TriNetX Research Network was utilized to identify all patients undergoing orthopedic shoulder surgery between January 2004 and December 2022. Patient information was stratified by year and type of surgery including arthroplasty, arthroscopy, soft tissue procedures, bony procedures, fractures, tumor resection, and amputation. Data collected included patient sex, age, race and ethnicity. Rates of postoperative anticoagulation medications, deep vein thrombosis, and postoperative bleeding were recorded within 1 month of surgery. A sub-analysis was performed comparing propensity matched cohorts of patients with a preoperative hypercoagulable diagnosis compared to a non-hypercoagulable cohort. Statistical significance was defined as P < .05., Results: The overall rate of VTE and postoperative bleeding for the collective cohort was low (1.3% and 0.1% respectively). The highest rate of VTE events was 2019 (1.8%). The overall rate of patients receiving anticoagulation medication was 15.6% during the study period. The year with the highest rate for anticoagulation prescribing was 2015 for all shoulder surgery (19.2%). Patients undergoing amputation and arthroplasty procedures experienced the highest overall rates of postoperative anticoagulation prescribing (51.8 and 47.6% respectively), while tumor resection and arthroscopy procedures experienced the fewest (6.2% and 6.6% respectively). Patients with a hypercoagulable diagnosis experienced VTEs at significantly higher rates (7.0% versus 0.9%, respectively) and received more anticoagulation medications compared to the non-hypercoagulable group (20.6% versus 15.5%) CONCLUSION: The rate of VTE and bleeding related events for orthopedic shoulder surgeries is low. However, there is an increased rate of VTE in patients with hypercoagulability risk factors and in those undergoing arthroplasty, amputation, and fracture fixation., (Copyright © 2025. Published by Elsevier Inc.)

Background: Venous thromboembolism (VTE) is a serious complication following orthopedic shoulder surgery; however, research is limited involving the break-even cost-effectiveness of VTE prophylaxis. The purpose of this study was to determine whether the cost of aspirin and enoxaparin would break even for VTE prevention in patients following shoulder surgery., Methods: A drug retail database was used to obtain the lowest price for a course of aspirin (81 mg) and enoxaparin (40 mg) to perform a break-even cost analysis. Our institutional purchasing records were then searched to estimate the cost of treating a symptomatic VTE. The TriNetX national database was queried to establish a rate of VTE after shoulder surgery. A break-even cost analysis was performed by determining the absolute risk reduction (ARR). This value was used to calculate the number of patients who are treated to prevent a single VTE while breaking even on cost. Sensitivity analyses were performed for drugs that did not break even at the database-derived VTE rates., Results: Full medication courses of aspirin and enoxaparin were found to cost $1.18 and $125.37, respectively. The cost of treating a symptomatic VTE was determined to be $9407.00. Data from the TriNetX database showed rates of symptomatic VTE following shoulder arthroplasty, hemiarthroplasty, and arthroscopic rotator cuff repair of 1.60%, 1.50%, and 0.68%, respectively. Aspirin broke even on cost for all procedures if the initial rate decreased by an ARR of 0.01% (number needed to treat, 7972). Similarly, enoxaparin broke even for shoulder arthroplasty and hemiarthroplasty if the initial rate of VTE decreased by an ARR of 1.33% (number needed to treat, 75). Enoxaparin did not break even at the initial VTE rate for arthroscopic rotator cuff repair; however, sensitivity analysis found enoxaparin would break even if the drug could be obtained at a cost of ≤$60.00. Enoxaparin broke even if the cost of treating a symptomatic VTE was ≥$20,000.00., Conclusions: The cost of a 3-week course of twice-daily aspirin or once-daily enoxaparin breaks even for VTE prophylaxis following shoulder arthroplasty and hemiarthroplasty if these drugs reduce the VTE rate by a calculated ARR. Given the lower rate of VTE observed for patients undergoing arthroscopic rotator cuff repair, only the 3-week course of aspirin broke even under these conditions. Once-daily enoxaparin did not break even at current market rate. Further research is needed to help determine optimal VTE prophylaxis after shoulder surgery., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)