TL 18040 - Venous thromboembolism risk in foot and ankle surgical patients

Introduction: Venous thromboembolism (VTE) is the leading cause of preventable hospital death. There are several risk factors for VTE, of which orthopedic surgery is an important one. VTE risk is highest following major orthopedic surgery, and therefore, some form of prophylactic therapy is usually recommended. In contrast, the risk for VTE following foot and ankle surgery is less clear, as are guidelines on VTE prophylaxis in these patients. Objective: To estimate the risk of VTE and the duration of the increased risk period after foot and ankle surgery. Methods: Data from a large population-based case–control study (the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis [MEGA] study) on the etiology of venous thrombosis were used (4721 cases; 5638 controls). Odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex and body mass index (ORadj), were calculated for patients undergoing any foot or ankle intervention before the index date (VTE date or control date). Results: The 263 cases and 94 controls underwent any orthopedic intervention in the year before the index date for an ORadj of 3,74 (95% CI 2,91-4,80) The ORadj in the first 90 days was 11,35 (95% CI 7,28-17,70). Fifty-five cases and 20 controls had a foot or ankle intervention in the year before the index date, resulting in a three-fold increased risk for VTE (OR 3,29, 95% CI 1,98-5,49). VTE risk was highest in the first 30 (ORadj 10,15 (95% CI 3,04-33,85)) and 90 days following surgery (ORadj 12,42, 95% CI 4,43-34,84). In 34 patients, the surgery was trauma-related, while 43 patients underwent elective surgery. Traumatic surgery was associated with a higher risk than elective surgery with an OR of 13,85 (95% CI 1,77-108,36) and 8,32 (95% CI 1,87-36,94), respectively, at 30 days. Conclusion: Foot and ankle procedures were associated with an increased VTE risk, which was highest in the first 90 days following surgery. Trauma-related surgery was associated with a higher VTE risk than elective surgery. These results are important for decisions regarding thromboprophylactic measures following foot and ankle surgery.

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Estimating Venous Thromboembolism Risk in Foot and Ankle Surgical Patients: A Base-Population Case-Control Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00453 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0045

Author(s):

Roberto Zambelli ◽

Banne Nemeth ◽

Carolina Touw ◽

Suely Rezende ◽

Suzanne Cannegieter

Keyword(s):

Orthopedic Surgery ◽

Index Date ◽

Case Control Study ◽

Elective Surgery ◽

Case Control ◽

Foot And Ankle ◽

Increased Risk ◽

Ankle Surgery ◽

First 90 Days ◽

Control Study

Category: Complications Introduction/Purpose: Venous thromboembolism (VTE) is the leading cause of preventable hospital death. There are several risk factors for VTE of which orthopedic surgery is an important one. VTE risk is highest following major orthopedic surgery and therefore some form of prophylactic therapy is usually recommended here. In contrast, the risk for VTE following foot and ankle surgery is less clear and so are guidelines on VTE prophylaxis in these patients. The purpose is to estimate the risk of VTE and the duration of the increased risk period after foot and ankle surgery. Methods: Data from a large population-based case–control study (the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis [MEGA] study) on the etiology of venous thrombosis were used (5129 cases; 5882 controls). Odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex and body mass index (ORadj) were calculated for patients undergoing any foot or ankle intervention before the index date (VTE date or control date). Results: 286 cases and 96 controls underwent any orthopedic intervention in the year before the index date for an ORadj of 3.7 (95%CI 2.9-4.8) The ORadj in the first 90-days was 11.4 (95%CI 7.3-17.7). 57 cases and 20 controls had a foot or ankle intervention in the year before the index date, resulting in a three-fold increased risk for VTE (OR 3.3, 95% CI 1,9-5.5). VTE risk was highest in the first 30 (ORadj 10.2,95%CI 3.0-33.9) and 90-days following surgery (ORadj 12.4, 95% CI 4.4-34.8). In 34 patients the surgery was trauma related while 43 patients underwent elective surgery. Traumatic surgery was associated with a higher risk compared with elective surgery for an OR of 13.9 (95%CI 1.8-108.4) and 8.3 (95%CI 1.9-36.9), respectively at 30-days. Conclusion: Foot and ankle procedures were associated with an increased VTE risk which was highest in the first 90-days following surgery. Trauma related surgery was associated with a higher VTE risk than elective surgery. These results are important to decide on thromboprophylactic measures following foot and ankle surgery.

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Incidence of Venous Thromboembolism in Orthopaedic Foot and Ankle Surgeries

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00108 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0010

Author(s):

Ashish Shah ◽

Samuel Huntley ◽

Harshadkumar Patel ◽

Eildar Abyar ◽

Eva Lehtonen ◽

...

Keyword(s):

Venous Thromboembolism ◽

Elective Surgery ◽

Meta Analysis ◽

Categorical Variables ◽

Continuous Variables ◽

Foot And Ankle ◽

Improvement Program ◽

Female Sex ◽

Increased Risk ◽

Ankle Surgery

Category: Other Introduction/Purpose: Venous thromboembolism (VTE) is a rare but potentially lethal complication following orthopaedic foot and ankle surgery. Surgeons continue to debate the types of patients and procedures in which it is appropriate to use chemical thromboprophylaxis. A recent meta-analysis concluded that patients at high risk for VTE after foot and ankle surgery should receive prophylaxis, but there remains a paucity of data to elucidate which demographic or comorbidity variables are most strongly associated with development of VTE. The incidence of VTE after orthopaedic foot and ankle surgery stratified by specific procedure has yet to be examined. The purpose of this study is to report the incidence of and identify risk factors for VTE in a large sample of patients receiving orthopaedic foot and ankle surgery. Methods: In this study, we retrospectively analyzed prospectively-collected data from the National Surgical Quality Improvement Program (NSQIP) 2006 to 2015 data files. The incidence of VTE was calculated for 30 specific orthopaedic foot and ankle surgeries and for four broad types of foot and ankle surgery. A total of 23,212 patients were identified and grouped by current procedures terminology (CPT) codes. Demographic, comorbidity, and complication variables were analyzed to determine associations with development of VTE. Pearson’s chi-squared test was used to compare categorical variables and Student t test was used to compare continuous variables. P-values of p<0.05 were considered statistically significant. Multivariable modelling was not possible due to the very low number of VTE cases relative to non-VTE cases. Results: The mean age at the time of surgery was 52.7±17.8 years. VTE events were documented 142 times in our sample, yielding an overall sample VTE incidence of 0.6%. The types of procedures with the highest frequency of VTE were ankle fractures (105/15,302 cases, 0.7%), foot pathologies (28/5,466, 0.6%), and arthroscopy (2/398, 0.5%). Female sex, increasing age, obesity level, inpatient status, and non-elective surgery were all significantly associated with VTE events. Postoperative pneumonia was significantly associated with VTE development. Patients who developed a VTE stayed at the hospital after surgery significantly longer than patients without VTE (6.2 vs. 3.1 days). Patients who developed VTE also had significantly higher estimated probability of morbidity (8.0% vs. 6.0%) and mortality (2.0% vs. 1.0%) when compared to patients without VTE. Conclusion: The present study confirms that VTE events after foot and ankle procedures are rare. The data presented suggest that female sex, increasing age, higher BMI, inpatient status, and non-elective procedures are associated with increased risk for VTE after orthopaedic foot and ankle surgery. Prospective, randomized, controlled trials are necessary to definitively determine the efficacy of chemoprophylaxis and to develop evidence-based clinical practice guidelines to minimize VTE after foot and ankle procedures.

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Incidence of and Risk Factors for Venous Thromboembolism After Foot and Ankle Surgery

Foot & Ankle Specialist ◽

10.1177/1938640018769740 ◽

2018 ◽

Vol 12 (3) ◽

pp. 218-227 ◽

Cited By ~ 6

Author(s):

Samuel R. Huntley ◽

Eildar Abyar ◽

Eva J. Lehtonen ◽

Harshadkumar A. Patel ◽

Sameer Naranje ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Female Gender ◽

Risk Groups ◽

Foot And Ankle ◽

Improvement Program ◽

True Incidence ◽

Ankle Surgery ◽

Data Files ◽

Retrospective Comparative Study

Background: Venous thromboembolism (VTE) is a rare but potentially lethal complication after orthopaedic foot and ankle surgery. The true incidence of VTE after orthopaedic foot and ankle surgery stratified by specific procedure has yet to be examined. The purpose of this study is to report the incidence of and identify risk factors for VTE in a large sample of patients receiving orthopaedic foot and ankle surgery. Methods: In this study, we retrospectively analyzed data from the National Surgical Quality Improvement Program 2006 to 2015 data files. The incidence of VTE was calculated for 30 specific orthopaedic foot and ankle surgeries and for 4 broad types of foot and ankle surgery. Demographic, comorbidity, and complication variables were analyzed to determine associations with development of VTE. Results: The overall incidence of VTE in our sample was 0.6%. The types of procedures with the highest frequency of VTE were ankle fractures (105/15 302 cases, 0.7%), foot pathologies (28/5466, 0.6%), and arthroscopy (2/398, 0.5%). Female gender, increasing age, obesity, inpatient status, and nonelective surgery were all significantly associated with VTE. Conclusion: Although VTE after orthopaedic foot and ankle surgery is a rare occurrence, several high-risk groups and procedures may be especially indicated for chemical thromboprophylaxis. Levels of Evidence: Level III: Retrospective, comparative study

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Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

World Journal of Pediatric Surgery ◽

10.1136/wjps-2019-000084 ◽

2020 ◽

Vol 3 (1) ◽

pp. e000084

Author(s):

Elbert Johann Mets ◽

Ryan Patrick McLynn ◽

Jonathan Newman Grauer

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Adverse Events ◽

General Surgery ◽

Elective Surgery ◽

Cohort Analysis ◽

Adverse Outcomes ◽

Trauma Patients ◽

Improvement Project ◽

Increased Risk

BackgroundAlthough less common in adults, venous thromboembolism (VTE) in children is a highly morbid, preventable adverse event. While VTE has been well studied among pediatric hospitalized and trauma patients, limited work has been done to examine postoperative VTE in children undergoing surgery.MethodsUsing data from National Surgical Quality Improvement Project Pediatric database (NSQIP-P) from 2012 to 2016, a retrospective cohort analysis was performed to determine the incidence of, and risk factors for, VTE in children undergoing surgery. Additionally, the relationships between VTE and other postoperative adverse outcomes were evaluated.ResultsOf 361 384 pediatric surgical patients, 378 (0.10%) were identified as experiencing postoperative VTE. After controlling for patient and surgical factors, we found that American Society of Anesthesiologists (ASA) class of II or greater, aged 16–18 years, non-elective surgery, general surgery (compared with several other surgical specialties), cardiothoracic surgery (compared with general surgery) and longer operative time were significantly associated with VTE in pediatric patients (p<0.001 for each comparison). Furthermore, a majority of adverse events were found to be associated with increased risk of subsequent VTE (p<0.001).ConclusionIn a large pediatric surgical population, an incidence of postoperative VTE of 0.10% was observed. Defined patient and surgical factors, and perioperative adverse events were found to be associated with such VTE events.

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New Approach for Evaluation of Quantitative Risk Factors of Venous Thromboembolism Using Individualized Reference Values.

Blood ◽

10.1182/blood.v106.11.4022.4022 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4022-4022

Author(s):

Rainer B. Zotz ◽

Andrea Gerhardt ◽

Rudiger E. Scharf

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Reference Values ◽

Protein S ◽

Healthy Controls ◽

New Approach ◽

Increased Risk ◽

Risk Determinants ◽

Protein S Activity

Abstract The evaluation of quantitative risk factors of venous thromboembolism is characterized by several unsolved problems. The majority of quantitative components of hemostasis are dependent on age, sex, and hormone intake. The cut-off values determined in case-control studies depend on the specific patient/control group and can not be generalized on individuals with other characteristics. Furthermore, the approach does not give reference values dependent on age, sex, and hormone intake which are necessary for risk estimations in clinical practice. To overcome these disadvantages, we used a multiple regression analysis to create a system of reference values which change continuously depending on age, sex, and hormone intake according to the parameter distribution in healthy controls and calculated the relative risk of hemostatic components (729 patients with first VTE and 675 healthy controls). A significantly increased risk for venous thrombosis was associated with deficiency of protein S activity (odds ratio (OR) 2.8 to 6.1, p=0.0007), free protein S concentration (OR 2.7 to 20.4, p=0.0001), protein C activity (OR 3.2 to 9.4, p=0.0001), antithrombin activity (OR up to 75, p=0.0001), and increased levels of fibrinogen (OR 3.8, p=0.0001), factor VIII:C (OR 3.3, p=0.0001), factor IX (OR 2.3, p=0.0001), factor XI (OR 2.9, p=0.0001), vWF activity (OR 2.4, p=0.0001), and vWF antigen (OR 3.5, p=0.0001). In contrast to previously published studies, this new approach gives clinically important cut-off values dependent on age, sex, and hormone intake and allows to identify patients at increased risk for venous thrombosis on an individualized basis. Particularly parameters which are highly dependent on age and sex, like protein S activity, can be characterized more precisely using the described procedure. This comprehensive analysis demonstrates that, apart from well-known risk determinants, deficiency of protein S and increased values of FI, FVIII:C, FIX, FXI, vWF, and vWF-Ag are risk determinants predicting venous thrombosis.

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Venous Thromboembolism - A Manifestation of the Metabolic Syndrome?.

Blood ◽

10.1182/blood.v108.11.1499.1499 ◽

2006 ◽

Vol 108 (11) ◽

pp. 1499-1499

Author(s):

Cihan Ay ◽

Theres Tengler ◽

Rainer Vormittag ◽

Ralph Simanek ◽

Wolfgang Dorda ◽

...

Keyword(s):

Risk Factors ◽

Metabolic Syndrome ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Factor Viii ◽

Factor V Leiden ◽

High Risk Population ◽

Factor Viii Activity ◽

The Metabolic Syndrome ◽

Increased Risk

Abstract There is accumulating evidence for an association between atherosclerosis and venous thrombosis, which may share common risk factors. The metabolic syndrome (MetSyn), a cluster of interrelated risk factors comprising abdominal obesity, elevated blood pressure, high triglycerides, reduced high-density lipoprotein cholesterol and elevated fasting glucose plasma levels is associated with atherosclerotic disease and type 2 diabetes mellitus. It induces a proinflammatory and prothrombotic state. Despite its high prevalence, data on the association with venous thromboembolism (VTE) are scarce. Therefore, we aimed to investigate the association of the MetSyn with the risk for VTE and conducted a case-control study to evaluate the prevalence of the MetSyn according to guidelines of the National Cholesterol Education Program in a high-risk population of patients with objectively confirmed recurrent VTE, who had at least one unprovoked event of deep venous thrombosis or pulmonary embolism. Age and sex-matched healthy individuals served as controls. Finally, a total of 116 patients (53 female, mean age +/−SD: 56 years +/−12) and 129 controls (66 female, mean age +/−SD: 53 years +/−11) were recruited between January 2005 and November 2005. The prevalence of the MetSyn was statistically significantly higher in patients (40/116, 35%) than in controls (26/129, 20%, p=0.012). The unadjusted odds ratio (OR) of the MetSyn for VTE was 2.1 (95% CI [1.2–3.7], p=0.012) and remained statistically significant after adjustment for factor V Leiden, prothrombin G20210A variation and elevated factor VIII activity, sex and age (OR=2.2, 95% CI [1.1–4.2], p=0.024). Furthermore, individuals with the MetSyn (n=66) had significantly higher hs-CRP (median, [interquartile range]: 0.312 mg/dL, [0.142–0.751] vs. 0.153 mg/dL, [0.073–0.330], p<0.001), fibrinogen (390 mg/dL, [342–432] vs. 343 mg/dL, [310–394], p<0.001) and factor VIII activity (182%, [157–216] vs. 159%, [133–199], p=0.005) compared to those without (n=179). In conclusion, the MetSyn was statistically significantly overrepresented in patients with VTE compared to control subjects without a history of venous or arterial thrombosis. Our data suggest that the MetSyn may contribute to the development of VTE as it was associated with a 2-fold increased risk for VTE.

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The influence of thrombophilia and obesity on the risk of venous thrombosis

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2017-95-6-545-548 ◽

2017 ◽

Vol 95 (6) ◽

pp. 545-548 ◽

Cited By ~ 1

Author(s):

Y. Belenkov ◽

Anna V. Golub ◽

L. Popova ◽

E. Shelest ◽

L. Patrushev ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Hormonal Contraceptives ◽

Increased Risk ◽

High Bmi

Risk factors of venous thromboembolism are acquired factors such as obesity, hormonal contraceptives, immobilization, and thrombophilia. Their combination leads to an increased risk of venous thrombosis. Objective: The aim of the study was to investigate effect of high BMI on the risk of venous thrombosis in patients with thrombophilia. Material and methods. We examined 96 patients with thrombophilia (mean age 51.61 years, 42 women and 54 men) and 73 patients without mutations (mean age 41.12 years, 17 men and 56 women) with different BMI. The first group involved 31 patients with venous thromboembolism, the second group included 15 patients. Results. The combination of BMI > 25 kg/m2 and thrombophilia influences the risk of venous thromboembolism.

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Incidence and Risk Factors of Venous Thromboembolism After Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011416s00202 ◽

2016 ◽

Vol 1 (1) ◽

pp. 2473011416S0020

Author(s):

Jamal Ahmad ◽

Mary-Katherine Lynch ◽

Mitchell Maltenfort

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Foot And Ankle ◽

Ankle Surgery

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Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100718794851 ◽

2018 ◽

Vol 40 (1) ◽

pp. 98-104 ◽

Cited By ~ 5

Author(s):

Johanna Marie Richey ◽

Miranda Lucia Ritterman Weintraub ◽

John M. Schuberth

Keyword(s):

Risk Factors ◽

Hormone Replacement ◽

Case Series ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Ankle Surgery ◽

History Of ◽

Low Incidence ◽

Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

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Forty-One-Year-Old Man with Pulmonary Embolism 5 Months After COVID-19

Clinical Medicine Insights Circulatory Respiratory and Pulmonary Medicine ◽

10.1177/1179548420986659 ◽

2021 ◽

Vol 15 ◽

pp. 117954842098665

Author(s):

Muhanad Taha ◽

Paul Nguyen ◽

Aditi Sharma ◽

Mazen Taha ◽

Lobelia Samavati

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

High Risk ◽

Venous Thrombosis ◽

Case Summary ◽

One Year

Background: Hypercoagulation is one of the striking features of COVID-19. Patients hospitalized with COVID-19 are at high risk for venous thromboembolism. However, it is unknown if the risk for venous thromboembolism persists after discharge. Case Summary: We report a case with pulmonary embolism 5 months after COVID-19. No risk factors for venous thrombosis have been identified. Conclusion: In COVID-19 related hospitalization, large studies are needed to identify the risk of venous thromboembolism after discharge.

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