Venous thromboembolic events following foot and ankle surgery in the English National Health Service

Abstract

Diagnostic and operative codes are routinely collected for every patient admitted to hospital in the English NHS. Data on post-operative complications following foot and ankle surgery have not previously been available in large numbers. Data on symptomatic venous thromboembolism events and mortality within 90 days were extracted for patients undergoing fixation of an ankle fracture, first metatarsal osteotomy, hindfoot fusions and total ankle replacement over a period of 42 months. For ankle fracture surgery (45 949 patients), the rates of deep-vein thrombosis (DVT), pulmonary embolism and mortality were 0.12%, 0.17% and 0.37%, respectively. For first metatarsal osteotomy (33 626 patients), DVT, pulmonary embolism and mortality rates were 0.01%, 0.02% and 0.04%, and for hindfoot fusions (7033 patients) the rates were 0.03%, 0.11% and 0.11%, respectively. The rate of pulmonary embolism in 1633 total ankle replacement patients was 0.06%, and there were no recorded DVTs and no deaths. Statistical analysis could only identify risk factors for venous thromboembolic events of increasing age and multiple comorbidities following fracture surgery. Venous thromboembolism following foot and ankle surgery is extremely rare, but this subset of fracture patients is at a higher risk. However, there is no evidence that thromboprophylaxis reduces this risk, and these national data suggest that prophylaxis is not required in most of these patients.

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

“…[7][8][9][10] The decision whether or not to use thrombosis chemoprophylaxis is therefore decided by weighing up the patient's risk for bleeding against the risk of developing VTE. No universal guidelines are available, although the general consensus from various bodies [31,34,38,40] and published articles [6,12,13,21,22,24,25,27,30,33,39] is that use of prophylactic anticoagulation is not advocated in foot and ankle surgery In a previous prospective study, [37] we found that the absolute number of cases of VTE after foot and ankle surgery was unacceptably high (11/130 (8.5%)), although this was not statistically significant owing to the relatively small number of cases. We identified a cohort of patients who were particularly prone to developing VTE after foot and ankle surgery.…”

“…A database study in the National Health Service in the UK found that the rate of symptomatic VTED following ankle fracture surgery, total ankle replacement, hindfoot arthrodesis or first metatarsal surgery was <0.3% for each type of surgery. [34] Mizel et al [21] found prevalences of symptomatic DVT and non-fatal PE of 0.22% and 0.15%, respectively.…”

The incidence of deep vein thrombosis and pulmonary embolism after fracture of the tibia: An analysis of the National Trauma Databank

“…Jameson et al studied the National Health Service hospital database and suggested ankle fracture fixation in patients over 50 as being a risk factor for VTE. 6 After studying the American…”

Thrombembolic complications after total ankle replacement

“…In the literature the question of whether TAR patients need thromboprophylaxis or not remains unanswered. Jameson et al [82] analyzed venous thrombembolic events following foot and ankle surgery in the English National Health Service between January 2005 and June 2008. In total, 1633 patients with TAR were included into this study.…”

“…In total, 1633 patients with TAR were included into this study. No deep vein thrombosis and only case of non-fatal pulmonary embolism (0.061 %) were observed [82]. However, in recent literature the incidence of thrombembolic complications should not be underestimated [23,27].…”