SLR - July 2009 - Courtney Watkins
Reference:
Felcher, A., Mularski, R., Mosen D., Kmes T., Deloughery T., Laxson S. (2009). Incidence and risk factors for venous thromboembolic disease in podiatric surgery. Chest, 135, 917-922.
Scientific Literature Reviews
Reviewed by: Courtney Watkins, DPM
Residency Program: Miami VA Medical Center
Podiatric Relevance:
This study provides information to determine the incidence and risk factors for post-procedure venous thromboembolic (VTE) disease in podiatric surgery.
Methods:
A 5-year retrospective study of patients undergoing podiatric surgery in a large not-for-profit HMO serving > 485,000 members in the Pacific Northwest was performed from 1999 to 2004 (can I interest anyone in a verb please?). The database was analyzed by using ICD-9 codes to determine patients who had undergone podiatric procedures and those patients with documented history of deep vein thrombosis (DVT) or pulmonary embolism (PE). Post-procedure VTE was defined as symptomatic DVT and/or PE within 6 months of procedure. A positive Duplex ultrasound was required for a diagnosis of DVT. Either a high probability ventilation/perfusion scan or positive CT angiogram were required for PE. All patients were analyzed for the presence or absence of the following VTE risk factors: active cancer; prior VTE; known hypercoagulable state; advanced age; obesity; use of HRT or OCP within 3 months of surgery.
Results:
A total of 7,264 patients underwent 16,804 podiatric procedures. Of these, 2,254 were inpatients and 5,010 were outpatients. There were 12 symptomatic DVTs (0.16% incidence rate) and 10 symptomatic PEs (0.14% incidence rate). The overall incidence of VTE was 0.30%. No fatal PEs were recorded. Mean time to VTE was 52 days. There were three individual risk factors significantly associated with the development of podiatric procedure-related VTE: prior VTE (4.6% incidence rate), obesity (0.48% incidence rate), and HRT/OCP use (0.55% incidence rate). Patients with two or more risk factors for VTE had an average incidence of VTE of 1.13% compared to patients with no risk factors.
Conclusions:
On the basis of these findings, there is a low overall risk of VTE (0.30%) in podiatric surgery, suggesting that routine prophylaxis is not warranted. However, for patients with a history of VTE, perioperative prophylaxis is suggested based on moderate to high level of risk. For podiatric surgery patients with two or more risk factors for VTE, perioperative prophylaxis should be considered on a case to case basis. Prospective studies are needed to test recommendations, guidelines, and care, until then decisions will continue to be based on retrospective data and clinical judgment.