Venous thromboembolism (VTE) is a potential complication of foot and ankle surgery. There is a lack of agreement on contributing risk factors and chemical prophylaxis requirements. The primary outcome of this study was to analyze the 90-day incidence of symptomatic VTE and VTE-related mortality in patients undergoing foot and ankle surgery and Achilles tendon (TA) rupture. Secondary aims were to assess the variation in the provision of chemical prophylaxis and risk factors for VTE. This was a multicentre, prospective national collaborative audit with data collection over nine months for all patients undergoing foot and ankle surgery in an operating theatre or TA rupture treatment, within participating UK hospitals. The association between VTE and thromboprophylaxis was assessed with a univariable logistic regression model. A multivariable logistic regression model was used to identify key predictors for the risk of VTE.Aims
Methods
The incidence of deep-vein thrombosis (DVT) and
pulmonary embolism (PE) is thought to be low following foot and ankle
surgery, but the routine use of chemoprophylaxis remains controversial.
This retrospective study assessed the incidence of symptomatic venous
thromboembolic (VTE) complications following a consecutive series
of 2654 patients undergoing elective foot and ankle surgery. A total
of 1078 patients received 75 mg aspirin as routine thromboprophylaxis
between 2003 and 2006 and 1576 patients received no form of chemical
thromboprophylaxis between 2007 and 2010. The overall incidence
of VTE was 0.42% (DVT, 0.27%; PE, 0.15%) with 27 patients lost to follow-up.
If these were included to create a worst case scenario, the overall
VTE rate was 1.43%. There was no apparent protective effect against
VTE by using aspirin. We conclude that the incidence of VTE following foot and ankle
surgery is very low and routine use of chemoprophylaxis does not
appear necessary for patients who are not in the high risk group
for VTE.
