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.
Felcher
Andrew H
AH
Northwest Permanente Medical Group, Portland, OR.
Mularski
Richard A
RA
The Center for Health Research, Kaiser Permanente Northwest, Portland, OR. Electronic address: richard.a.mularski@kpchr.org.
Mosen
David M
DM
The Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
Kimes
Teresa M
TM
The Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
DeLoughery
Thomas G
TG
Oregon Health and Sciences University, Portland, OR.
Laxson
Steven E
SE
Northwest Permanente Medical Group, Portland, OR.
D005260:Female; D005528:Foot / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011032:Podiatry; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control