Current Trends in Thromboprophylaxis in Surgery of the Foot and Ankle

2007 ◽  
Vol 28 (10) ◽  
pp. 1069-1073 ◽  
Author(s):  
Aniruth Gadgil ◽  
Rhys H. Thomas
Keyword(s):  
Best Practice ◽  
Significant Proportion ◽  
Foot And Ankle ◽  
Thromboembolic Prophylaxis ◽  
Current Trends ◽  
Published Evidence ◽  
Ankle Surgery ◽  
Hip And Knee Arthroplasty ◽  
Wide Variability ◽  
Common Situation

Background: Few studies exist to guide the best practice in thromboprophylaxis after foot and ankle surgery. A survey of foot and ankle surgeons was performed to assess current trends in thromboprophylaxis. Methods: An email-based survey of American and British foot and ankle surgeons was conducted. Surgeons were questioned as to their use and type(s) of thromboprophylaxis as well as reasons for not using prophylaxis. Surgeons also were asked about their use of thromboprophylaxis in hip and knee arthroplasty, if they did these surgeries. Results: Nearly one-fifth (19%, 27) of surgeons routinely used thromboprophylaxis in both elective and trauma foot and ankle surgery. The most common situation for use was in a postoperative patient who was immobilized and nonweightbearing. A lack of published evidence and a low rate of thromboembolism were the most commonly cited reasons for not using thromboprophylaxis. Conclusions: This survey showed a wide variability in thromboembolic prophylaxis. It suggests that despite the literature indicating to the contrary, a significant proportion of foot and ankle surgeons routinely use thromboprophylaxis. Confusion remains regarding the appropriateness of thromboprophylaxis and what type(s)(if any) should be used. This study has identified a need for more in-depth evaluation of the importance of, and possible prophylaxis against, thromboembolic problems after foot and ankle surgery.

Prevalence and Safety of Left-Footed Driving Following Right Foot Surgery Patients Including a Driving Simulation

2019 ◽  
Vol 40 (7) ◽  
pp. 818-825 ◽  
Author(s):  
Haley M. McKissack ◽  
Yvonne E. Chodaba ◽  
Tyler R. Bell ◽  
Eva J. Lehtonen ◽  
Ibukunoluwa B. Araoye ◽  
...  
Keyword(s):  
Driving Simulator ◽  
Recovery Period ◽  
Significant Proportion ◽  
Case Series ◽  
Postoperative Recovery ◽  
Foot And Ankle ◽  
Foot Surgery ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
The Right

Background: For many patients, returning to driving after right foot and ankle surgery is a concern, and it is not uncommon for patients to ask if driving may be performed with their left foot. A paucity of literature exists to guide physician recommendations for return to driving. The purpose of this study was to describe the driving habits of patients after right-sided foot surgery and assess the safety of left-footed driving using a driving simulator. Methods: Patients who underwent right foot or ankle operations between January 2015 and December 2015 were retrospectively identified. A survey assessing driving habits prior to surgery and during the recovery period was administered via a REDCap database through email or telephone. Additionally, simulated driving scenarios were conducted using a driving simulator in 20 volunteer subjects to compare characteristics of left- versus right-footed driving. Results: Thirty-six of 96 (37%) patients who responded to the survey reported driving with the left foot postoperatively. No trends were found associating left-footed driving prevalence and socioeconomic status. In driving simulations, patients exceeded the speed limit significantly more ( P < .001) and hit other vehicles more ( P < .026) when driving with the right foot than the left. The time to fully brake and fully release the throttle in response to vehicular hazards was significantly prolonged in left-footed driving compared with right ( P = .019 and P = .034, respectively). Conclusion: A significant proportion of right foot ankle surgery patients engaged in left-footed driving during postoperative recovery. Driving with both the right and left foot presents a risk of compromised safety. This study provides novel objective data regarding the potential risks of unipedal left-footed driving using a standard right-footed console, which indicates that driving with the left foot may prolong brake and throttle release times. Further studies are warranted for physicians to be able to appropriately advise patients about driving after foot and ankle surgery. Level of Evidence: Level IV, case series.

scholarly journals Validation and Generalizability of Preoperative PROMIS Scores to Predict Postoperative Success in Foot and Ankle Patients

2018 ◽  
Vol 39 (7) ◽  
pp. 763-770 ◽  
Author(s):  
Michael R. Anderson ◽  
Jeff R. Houck ◽  
Charles L. Saltzman ◽  
Man Hung ◽  
Florian Nickisch ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Area Under The Curve ◽  
Functional Improvement ◽  
Published Data ◽  
Foot And Ankle ◽  
Threshold Values ◽  
Meaningful Improvement ◽  
Geographic Population ◽  
Ankle Surgery ◽  
Patient Reported

Background: A recent publication reported preoperative Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) scores to be highly predictive in identifying patients who would and would not benefit from foot and ankle surgery. Their applicability to other patient populations is unknown. The aim of this study was to assess the validation and generalizability of previously published preoperative PROMIS physical function (PF) and pain interference (PI) threshold t scores as predictors of postoperative clinically meaningful improvement in foot and ankle patients from a geographically unique patient population. Methods: Prospective PROMIS PF and PI scores of consecutive patient visits to a tertiary foot and ankle clinic were obtained between January 2014 and November 2016. Patients undergoing elective foot and ankle surgery were identified and PROMIS values obtained at initial and follow-up visits (average, 7.9 months). Analysis of variance was used to assess differences in PROMIS scores before and after surgery. The distributive method was used to estimate a minimal clinically important difference (MCID). Receiver operating characteristic curve analysis was used to determine thresholds for achieving and failing to achieve MCID. To assess the validity and generalizability of these threshold values, they were compared with previously published threshold values for accuracy using likelihood ratios and pre- and posttest probabilities, and the percentages of patients identified as achieving and failing to achieve MCID were evaluated using χ2 analysis. Results: There were significant improvements in PF ( P < .001) and PI ( P < .001) after surgery. The area under the curve for PF (0.77) was significant ( P < .01), and the thresholds for achieving MCID and not achieving MCID were similar to those in the prior study. A significant proportion of patients (88.9%) identified as not likely to achieve MCID failed to achieve MCID ( P = .03). A significant proportion of patients (84.2%) identified as likely to achieve MCID did achieve MCID ( P < .01). The area under the curve for PROMIS PI was not significant. Conclusions: PROMIS PF threshold scores from published data were successful in classifying patients from a different patient and geographic population who would improve with surgery. If functional improvement is the goal, these thresholds could be used to help identify patients who will benefit from surgery and, most important, those who will not, adding value to foot and ankle health care. Level of evidence: Level II, Prospective Comparative Study

Venous Thromboembolic Prophylaxis in Foot and Ankle Surgery: A Review of Current Literature and Practice

2017 ◽  
Vol 10 (4) ◽  
pp. 343-351 ◽  
Author(s):  
Martin H. S. Weisman ◽  
James R. Holmes ◽  
Todd A. Irwin ◽  
Paul G. Talusan
Keyword(s):  
Risk Factors ◽  
Survey Study ◽  
Foot And Ankle ◽  
Thromboembolic Prophylaxis ◽  
Vte Prophylaxis ◽  
Perioperative Phase ◽  
Ankle Surgery ◽  
Significant Difference ◽  
Venous Thromboembolic ◽  
Low Incidence

Venous thromboembolism (VTE) is a well-known and feared complication following foot and ankle surgery, as it is a source of morbidity and mortality in the perioperative phase. The most recent CHEST guidelines recommended against the use of chemoprophylaxis and the majority of the literature has found a low incidence of VTE following foot and ankle surgery. Some authors prefer screening patients for risk factors and recommend the use of chemoprophylaxis on a case-by-case basis. Interestingly, studies that found high incidence of VTE were unable to determine a statistically significant difference between the prophylaxis and placebo groups. Major limitations of retrospective reviews is they are only able to study symptomatic VTE because no routine screening is typically performed. In a survey study, up to 98% of foot and ankle surgeons responded that they use prophylaxis in high-risk patients. Despite evidence-based recommendations, a significant number of foot and ankle surgeons are routinely using some form of VTE prophylaxis without taking risk factors into account. Levels of Evidence: Clinical, Level IV: Review Article

scholarly journals Prevalence and Safety of Left-Footed Driving in Right Foot Surgery Patients: A Retrospective Survey and Driving Simulation Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0005
Author(s):  
Haley M. McKissack ◽  
Yvonne E. Chodaba ◽  
Tyler R. Bell ◽  
Eva J. Lehtonen ◽  
Ibukunoluwa B. Araoye ◽  
...  
Keyword(s):  
Driving Simulator ◽  
Recovery Period ◽  
Significant Proportion ◽  
Postoperative Recovery ◽  
Foot And Ankle ◽  
Foot Surgery ◽  
Release Times ◽  
Ankle Surgery ◽  
The Right ◽  
Physician Recommendations

Category: Post-operative Driving Introduction/Purpose: For many patients, returning to driving after right foot and ankle surgery is a concern, and it is not uncommon for patients to ask if driving may be performed with their left foot. A paucity of literature exists to guide physician recommendations for return to driving. The purpose of this study is to describe the driving habits of patients after right-sided foot surgery and assess the safety of left foot driving using a driving simulator. Methods: Patients who underwent right foot or ankle operations between January 2015 and December 2015 were retrospectively identified. A survey assessing driving habits prior to surgery and during the recovery period was administered via REDCap database through email or telephone. Additionally, simulated driving scenarios were conducted using a driving simulator in 20 patients to compare characteristics of left versus right foot driving. Results: Thirty six of 96 (37%) patients who responded to the survey reported driving with the left foot postoperatively. No trends were found associating left foot driving prevalence and socioeconomic status. In driving simulations, patients exceeded the speed limit significantly more (p<0.001) and hit other vehicles more (p<0.026) when driving with the right foot than the left. Time to fully brake and fully release the throttle in response to vehicular hazards were significantly prolonged in left foot driving compared to right (p = 0.019 and p = 0.034, respectively). Conclusion: A significant proportion of right foot and ankle surgery patients engaged in left foot driving during postoperative recovery. Driving with the left foot may prolong brake and throttle release times, and is therefore not recommended.

scholarly journals Postoperative infection rates in foot and ankle surgery: a clinical audit of Australian podiatric surgeons, January to December 2007

2010 ◽  
Vol 34 (2) ◽  
pp. 180 ◽  
Author(s):  
Paul Butterworth ◽  
Mark F. Gilheany ◽  
Paul Tinley
Keyword(s):  
Best Practice ◽  
Clinical Audit ◽  
International Classification Of Diseases ◽  
Complication Rates ◽  
Foot And Ankle ◽  
Infection Rates ◽  
Hospital System ◽  
Patient Admissions ◽  
Ankle Surgery ◽  
Podiatric Surgery

Background.Surgical site infections are one of the most common post-operative complications encountered by foot and ankle surgeons. The incidence reported in the literature varies between 0.5 and 6.5%. The results of a 12-month Australia-wide clinical audit analysing the rates of postoperative infections in association with podiatric surgery are presented. Methods.De-identified patient data was collected from nine podiatric surgeons Australia-wide. Infections were identified according to Australian Council on Health Care Standards (ACHS) definitions and data was entered no earlier than thirty days post procedure. Results.A total of 1339 patient admissions and 2387 surgical procedures were reported using the International Classification of Diseases (ICD-10) and Medicare Benefit Schedule (MBS) coding systems. The overall infection rate was 3.1% and the rate of infection resulting in hospital re-admission was 0.25%. Conclusions.The benchmark results presented in this paper suggest that infection rates associated with podiatric surgery are well within accepted industry standards as stated in recent literature. What is known about the topic?The rates of infection in foot and ankle surgery have been reported in international literature to vary between 0.5 and 6.5%. No such data has been published to date, which describes the rate of infection following podiatric surgery in Australia. What does this paper add?This paper provides benchmark data on complication rates associated with Australian podiatric surgeons. Such data also informs health and hospital managers who may be considering podiatric surgery as an option for providing foot surgery services within the public hospital system. What are the implications for practitioners?This paper challenges podiatric surgeons to consider their own practice and whether it is a reflection of best practice.

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