Abstract
Category:
Other
Introduction/Purpose:
There is wide variation in the threshold and provision of thromboprophylaxis in the treatment of foot and ankle conditions. One of the difficulties in affecting change in practice in this area is the low incidence of postoperative, symptomatic VTE. Therefore, a large number of patients need to be included in any series for meaningful conclusions to be drawn.
Primary objective
To observe the UK-wide variation in post-operative thromboprophylaxis, and to analyse the 90-day incidence of symptomatic venous thrombo-embolism related to:
-Elective foot and ankle surgery
-Trauma foot and ankle surgery
-Treatment of Achilles tendon ruptures (operative and non-operative)
Methods:
This was a multi-centre prospective audit spanning a collection duration of 9 months. Primary outcomes included symptomatic VTE up to 90 days following foot & ankle surgery and Achilles tendon rupture and VTE related mortality up to 90 days following treatment. Secondary outcomes included methods of thromboprophylaxis used, and possible confounding variables and influencing factors for VTE.
Results:
A total of 10,983 patients were included from 56 sites in the UK. This was split into 51.72% trauma (n=5571), 3.78% diabetic surgery (n=415) and 45.18% elective surgery (n=4962). There was 95 VTE events across the whole cohort (0.86%). Diabetic foot disease surgery had the highest rate of VTE (Below knee amputation 5.3% and acute foot debridement 2.6%). The trauma diagnosis with the highest rate of VTE was Achilles tendon rupture (3.7%). All elective foot procedures had a VTE rate < 1% except elective tendon procedure (1.1%).
Factors with statistically significant association with VTE included trauma surgery where prophylaxis stopped greater than 1day pre surgery (p=.027), non-compliance with prophylaxis (p=.001), post-surgical infection (p=.005), and the comorbidities asthma (p=.014), cancer (p=.014), dementia (p=.001), diabetes (p=.005), stroke (p < 0.001) and recent long-distance travel (p=.048).
Conclusion:
This is a large-scale multicentre study which recorded multiple possible confounding variables. There were 12 different chemical prophylaxis used across the study, with the highest rate of VTE in patients administered Apixaban (4.9%). The most common chemical prophylaxis used in the study was Enoxaparin (27.19%) followed by Dalteparin (20.38%). There was no evidence of a decrease in VTE if mechanical prophylaxis was used. The study identified specific diagnosis with increased risk of VTE and comorbidities.