Introduction

Venous thromboembolism (VTE) is an uncommon complication of foot and ankle surgery but has the potential for significant morbidity and mortality. The incidence, risk factors and prevention of VTE in foot and ankle surgery is not clear.

Introduction: Long waiting times for surgery and government targets places added pressure on the administration of surgical units. In an effort to decrease waiting times from initial referral to surgery and to meet new to follow-up patient ratios set by the government, a policy of early discharge from follow-up was introduced for many procedures involving the foot and ankle. This audit assessed whether this policy increased procedure morbidity and patient dissatisfaction.

Methods: A 12-month retrospective audit was performed (October 2005 – September 2006) on the foot and ankle surgery cases performed at the Great Western Hospital, Swindon and Marlborough Trust, UK. Procedure and out-patient appointment data was accessed including new, follow up and ‘SOS’ patient attendances. Appointments were considered SOS if a patient sought consultation with a surgeon following discharge in the post operative setting.

Results: A total of 1128 foot and ankle procedures were performed on 639 patients. Eighty five percent (958) procedures met the early discharge from follow-up criteria. There were 2750 appointments for the respective period. Twelve hundred and seven (44%) were new patient appointments and 1543 (56%) were follow-up appointments. There were 84 SOS attendances related to a surgical episode, comprising 2% of appointments and 6% of procedures. Sixty-seven of the SOS attendances (80%) were related to an early discharge from follow-up procedure. A high proportion of SOS attendances were associated with joint stiffness, digital malposition and dysesthesia relating to Hallux Valgus correction, lesser digit arthrodesis and intermetatarsal neurectomy respectively.

Discussion: In this series, the aforementioned complications are consistent with those reported in the literature and we conclude they were not a consequence of early discharge. Early discharge from follow-up following selected common surgical procedures for the foot and ankle can potentially increase productivity of the out patient department without impact on procedure morbidity and patient satisfaction.

Purpose: An audit was undertaken to evaluate the patients’ experience of foot surgery at the great Western Hospital in 2004 following the appointment of a podiatric surgeon to the orthopaedic department.

Method: The first 100 patients that were operated on by the podiatric surgeon (Group 1) were matched by OPCS code to a randomly selected patient cohort that had been operated on by orthopaedic surgeons (Group 2). All patients were at a minimum of 6 months post-surgery (range 6–10 months Gp. 1, 11–20 months Gp. 2). The audit department sent out an anonymous questionnaire relating to the patients’ experience both before and after their surgery as well as current levels of satisfaction with the outcome of their surgery.

Results: The response rate was 64% in Gp.1 and 68% in Gp.2.

The patients’ overall satisfaction with the result of their foot surgery was determined using a Likert scale and the results can be seen in Table 1.

Patients in the podiatric surgical group were significantly more satisfied with the result of their foot surgery than those in the orthopaedic group (p< 0.008; Mann Whitney U test).

Similar statistically significant differences were also seen between the two groups relating to patient satisfaction with their pre and post-operative consultations and information concerning their proposed surgery and its outcome.

Conclusion: The results of this audit suggest that the satisfaction of patients following foot surgery can rise significantly following the appointment of a podiatric surgeon to a general hospital orthopaedic department.