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Incidence and Risk Factors for Venous Thromboembolic Disease in Podiatric Surgery

      Background

      The Agency for Healthcare Research and Quality ranks prevention of venous thromboembolism (VTE) as a top priority for patient safety; however, no guidelines or population-based research exist to guide management for podiatric surgery patients. The objective of our study was to determine the incidence and risk factors for postprocedure VTE in podiatric surgery.

      Methods

      A 5-year retrospective analysis of patients undergoing podiatric surgery in a large not-for-profit health maintenance organization serving > 485,000 members in the Pacific Northwest from 1999 to 2004.

      Results

      We identified 16,804 surgical procedures in 7,264 patients and detected 22 symptomatic postprocedure VTEs. The overall incidence of postprocedure VTE was 0.30%. Three risk factors were significantly and independently associated with VTE in podiatric surgery: prior VTE (incidence, 4.6%; relative risk, 23.0; p < 0.001), use of hormone replacement therapy or oral contraceptives (incidence, 0.55%; relative risk, 4.2; p = 0.01), and obesity (incidence, 0.48%; relative risk, 3.0; p = 0.02).

      Conclusions

      We identified a low overall risk of VTE in podiatric surgery, suggesting that routine prophylaxis is not warranted. However, for patients with a history of VTE, periprocedure prophylaxis is suggested based on the level of risk. For podiatry surgery patients with two or more risk factors for VTE, periprocedure prophylaxis should be considered. Until a prospective study is completed testing recommendations, guidelines and care decisions for podiatric surgery patients will continue to be based on retrospective data, expert consensus, and clinical judgment.

      Key words

      Abbreviations:

      BMI (body mass index), CI (confidence interval), DVT (deep vein thrombosis), HMO (health maintenance organization), HRT (hormone replacement therapy), ICD-9 (International Classification of Diseases, ninth revision), OCP (oral contraceptive pill), OR (odds ratio), PE (pulmonary embolism), VTE (venous thromboembolism)
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      Linked Article

      • Balancing the Risks and Benefits of Thromboprophylaxis in Patients Undergoing Podiatric Surgery
        CHESTVol. 135Issue 4
        • Preview
          Surgery and immobility are recognized as important acquired risk factors for the development of venous thromboembolism (VTE).1 Providing thromboprophylaxis to patients at moderate-to-high VTE risk has thus become an important patient safety initiative.2 Equally important has been a growing interest in identifying patients at low risk for VTE who do not need thromboprophylaxis, and who potentially may be unnecessarily subjected to the risks, costs, and inconvenience associated with thromboprophylaxis.
        • Full-Text
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      • Erratum: CHEST 2009; 135(4):917–922
        CHESTVol. 136Issue 2
        • Preview
          In the April 2009 issue, the article “Incidence and Risk Factors for Venous Thromboembolic Disease in Podiatric Surgery (CHEST 2009; 135(4):917–922)” by Felcher et al, contains an error in the headings for Table 4. Instead of reading “VTE events with renal failure” and “VTE events without renal failure” it should read “VTE events with risk factor” and “VTE events without risk factor.”
        • Full-Text
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