by Colby Baron, PA-S
Moving to higher elevation often has side effects on the body. To many people, these effects are well managed. They may feel a slight shortness of breath while exercising, an occasional headache relieved by a caffeinated drink, or some dry skin. Others are less fortunate. Their symptoms impact their daily lives. Regardless of how visible one’s symptoms may be, every human body must make physiologic internal changes to adapt to living at higher altitudes.
The body needs oxygen. While air still contains 21% oxygen in a high altitude environment, the density of the molecules is lower. When you arrive at a mountain town like Frisco, in the Rocky Mountains of Colorado with an elevation of 9,000 feet, the body works to pull whatever oxygen it can find into its system. It not only has to breathe harder to do so but creates more red blood cells so that it can be more efficient in transporting more oxygen to all tissues. While this adjustment works, it has its side effects: more red blood cell vehicles means more traffic along the blood vessel highways. Such blockage makes the blood more viscous and more prone to forming clots. This is not a a “death trap” for all but can have greater consequences for those already at risk of having a serious clotting event.
Surgery requires patients to remain immobile in recovery and often involves vascular injuries as the tissue is altered. Blood clots can form in these circumstances. This is managed with anti-platelet and anticoagulation drugs. Orthopedic procedures tend to present with the biggest risk. This is especially true when operating on the knee. Operations closer to the heart have less risk. Arthroscopic rotator cuff procedures typically only have about a 0.3-0.5% chance of causing any thrombotic issues. The stakes are altered significantly when altitude is factored into the equation. In a recent study in the Journal of Shoulder and Elbow Surgery published by orthopedic surgeons Matthew Cannefax, Michael T. Burrus, David R. Diduch, and Brian C. Werner, arthroscopic rotator cuff repairs done at elevations above 4,000 feet increased the rate of blood clots by 2 – 3 times as much. Deep vein thromboses, pulmonary embolisms, and other thrombotic complications lead to improved monitoring and follow up with patients post op.
My own shoulder surgery was at a lower elevation, requiring strict immobilization of my arm in a sling for 6 weeks straight, even while asleep. Even if I had wanted to remove my sling, my arm felt weak with significant pain every time I stretched my limits even accidentally. The constant restricted position I was forced to be in rarely felt comfortable. Adding the pain and systemic consequences of a blood clot would have emphasized those hardships even more. Frisco pediatrician Dr. Christine Ebert-Santos had shoulder surgery at 9,000 feet with immediate relief of the constant pain she suffered for 9 months and a rapid uncomplicated recovery. The advantages of receiving care in our home community outweighs the very small risk of increased complications from altitude for most mountain residents.
References
- Journal of Shoulder and Elbow Surgery, Cannefax M, Burrus MT, Diduch DR, Werner BC. Increased risk of venous thromboembolism following arthroscopic rotator cuff repair at high altitude. J Shoulder Elbow Surg. 2017;26(7):e207-e213. doi:10.1016/j.jse.2017.03.012
- American Academy of Orthopaedic Surgeons. Venous thromboembolism in orthopedic surgery. Accessed March 27, 2026. https://www.aaos.org
- Journal of Thrombosis and Haemostasis, Imray C, Booth A, Wright A, Bradwell AR. Thrombosis and coagulation at high altitude. J Thromb Haemost. 2010;8(3):499-504. doi:10.1111/j.1538-7836.2009.03700.
Colby Baron is physician assistant student at Rocky Mountain University in Provo, Utah. Ever since having lifesaving brain surgery when he was 15 years old to repair an idiopathic hemorrhagic stroke, Colby has tried to give back to the medical community any way that he can. As an active individual who loves soccer, board sports, skydiving, hiking, camping, and anything one can do outdoors, he lives an active lifestyle. Such a life has created many great memories but has also been the cause of several orthopedic injuries. He has had a broken leg, a dislocated kneecap, a torn meniscus, a torn labrum, and multiple concussions and sprained ankles. After graduating PA school, he hopes to use these past experiences and time spent in the OR assisting orthopedic surgeons with traumatic and pediatric cases to help others emphatically with their musculoskeletal issues. He feels great passion for this and hopes to positively impact patients and providers throughout his career.
