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Incidence and Risk Factors for Venous Thromboembolic Disease in Podiatric Surgery
Andrew H. Felcher; Richard A. Mularski; David M. Mosen; Teresa M. Kimes; Thomas G. DeLougehry and Steven E. Laxson Chest, doi:10.1378/chest.08-1631
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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 post-procedure VTE in podiatric surgery.
Methods: A five-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 post-procedure VTEs. The overall incidence of post-procedure VTE was 0.30%. Three risk factors were significantly and independently associated with VTE in podiatric surgery: prior VTE (incidence 4.6%, RR 23.0, p < 0.001), use of hormone replacement therapy or oral contraceptives (incidence 0.55%, RR 4.2, p = 0.01) and obesity (incidence 0.48%, RR 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 prior VTE, peri-procedure prophylaxis is suggested based on the level of risk. For podiatry surgery patients with two or more risk factors for VTE, peri-procedure 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.
Incidence and Risk Factors for Venous Thromboembolic Disease in Podiatric Surgery
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