Chest
Volume 135, Issue 4, April 2009, Pages 917-922
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Original Research
Venous Thromboembolic Disease
Incidence and Risk Factors for Venous Thromboembolic Disease in Podiatric Surgery

https://doi.org/10.1378/chest.08-1631Get rights and content

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.

Section snippets

Materials and Methods

We analyzed a large not-for-profit HMO database serving > 485,000 members using an integrated, group-model health delivery system to identify patients who had undergone podiatric procedures during the period from December 1999 to November 2004. A robust computerized electronic medical record system of all patient care activity is accessible. This study was approved by the Kaiser Permanente Northwest institutional review board; patient data were deidentified according to institutional review

Results

A total of 7,264 patients underwent 16,804 podiatric surgical procedures from December 1999 to November 2004 (Table 2); 5,128 patients underwent a single procedure, and 2,136 patients underwent multiple procedures. There were 2,254 patients with inpatient procedures and 5,010 patients with outpatient procedures.

Of the 7,264 patients undergoing podiatric surgery during this time period, there were 12 symptomatic DVTs and 10 symptomatic PEs for an overall number of 22 VTE events, giving an

Discussion

Our retrospective study of > 7,000 podiatry patients is the largest clinical investigation to date of VTE rates in podiatric surgery. The results of the analysis have four major findings. First, for all patients undergoing podiatric surgery, the overall rate of podiatric procedure-related symptomatic VTE is low at 0.30%. Second, we found a significant increased risk for postprocedure VTE in patients with prior VTE (4.6%), those receiving HRT/OCP (0.55%), or patients who were obese (0.48%),

Acknowledgment

We are indebted to Kathleen Souders for help with the administrative database, Kevin Lutz and Dixie Sweo for assistance with the preparation of this manuscript, and Dr. Karen Mularski for thoughtful critiques.

References (20)

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This study was supported by a grant from Kaiser Permanente Northwest Community Benefit Investment. The Kaiser Permanente Northwest Community Benefit Investment supports collaboration between clinical investigators from Northwest Permanente Medical Group and the Center for Health Research.

Dr. DeLoughery receives grant support or honoraria from GlaxoSmithKline, Aventis, and Baxter. The other authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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