SLR - April 2010 - Joshua Vest
Reference:
Incidence and Risk Factors in Venous Thromboembolic Disease in Podiatric Surgery. Chest, 135, 2009.
Scientific Literature Reviews
Reviewed by: Joshua Vest, DPM
Residency Program: Detroit Medical Center
Podiatric Relevance:
The authors of the article observed that there are currently no guidelines or population-based research to guide management and prevention of venous thromboembolism in patients undergoing podiatric surgery. As a result, they attempt to determine the risk factors and incidence of post-procedural venous thromboembolism in podiatric surgery.
Methods:
The authors performed a five year retrospective analysis of patients undergoing podiatric surgery at a large HMO serving nearly 500,000 people in the Kaiser Permanente health system. Patients undergoing inpatient or outpatient podiatric procedures were screened for a postprocedure VTE. A postprocedure VTE event was defined as any definitive and symptomatic DVT and/or PE occurring within 6 months of the procedure. They also reviewed all available studies in the podiatric and orthopedic literature on VTE prophylaxis in ankle/foot surgery.
Results:
The authors identified 16,804 surgical procedures in 7,264 patients and detected 22 symptomatic postprocedure VTEs, equaling a total overall incidence of postprocedure VTE of 0.30%. Three risk factors proved to be statistically and independantly associated with VTE. They were 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:
The authors concluded that there is an overall relatively low risk of VTE in podiatric surgery sugesting that routine prophylaxis is not necessary. The occurance of VTE in the patient population with a confirmed history of VTE is significant enough to warrant perioperative prophylaxis based on risk. They went on to suggest that patients who meet two or more of the three identified risk factors (prior VTE, hormone replacement or oral contraceptive use, or obesity) should also strongly be considered for perioperative prophylaxis. This was based on the finding that occurance of VTE increased from 3 per 1000 patients in healthy patients undergoing podiatric surgery to 11.3 per 1000 patients when the pts had two or more identified risk factors.
The authors do aknowledge the need for a prospective study to further giude VTE prophylaxis in podiatric surgery in regard to guidelines. In the meantime they suggest the decision to prophlylax be based on observational data, expert consensus, and clinical judgment.