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Correspondence |

Accuracy in Identifying Podiatric Surgeries FREE TO VIEW

Adam M. Budny, DPM; Lee C. Rogers, DPM
Author and Funding Information

From Blair Orthopedic Associates & Sports Medicine (Dr Budny), and Amputation Prevention Center (Dr Rogers) at Valley Presbyterian Hospital.

Correspondence to: Adam M. Budny, DPM, Blair Orthopedic Associates & Sports Medicine, 3000 Fairway Drive, Altoona, PA 16602; e-mail: abudnydpm@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2010 American College of Chest Physicians


Chest. 2010;137(1):242-243. doi:10.1378/chest.09-1869
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To the Editor:

We read with interest the recently published article in CHEST (April 2009) by Felcher et al.1 Although they should be commended for bringing emphasis to venous thromboembolic (VTE) disease as a postsurgical complication of foot surgery, we found a few areas of concern in their manuscript.

We noticed from Table 2 that nearly half of the outpatient procedures were either “foot injections” or “drainage of a joint/bursa/cyst.” These procedures have a low pretest probability of VTE and are generally not considered hazardous enough to warrant deep venous thrombosis (DVT) prophylaxis. Therefore, inclusion of these procedures biases the outcome toward a reduced risk. The other procedures listed are, for the most part, forefoot surgeries.

The purpose of the title of a medical journal article is to catch the attention of the readership and to provide a tag for search engines. Thus, the title should accurately represent the contents and conclusions of the article. We find the title of this article misleading for two reasons. First, the title implies that injections and aspirations are classified as surgeries. Second, when describing the “surgeries” performed, the authors use the term “podiatric,” which refers to a degree and not specifically an anatomic region. Their study did not include all the surgeries typically performed by surgeons with this degree. It appears that this study was limited to simple forefoot surgeries, and from what we can discern there were no ankle or leg surgeries. Thus, since the procedures studied did not include the full breadth of what the average podiatrist performs, it would be a mischaracterization to state that “the incidence of VTE is low for podiatric surgeries.” It is also confusing that the authors state that “only one study calculated VTE incidence rates in podiatric surgery”, but then subsequently cite six other studies regarding foot and ankle surgery that evaluate VTE, as if podiatric foot and ankle surgery were different from orthopedic foot and ankle surgery.

It is difficult for us to perform calculations on the data that were provided in this study since procedures and patients are reported separately, and some patients had more than one procedure. However, if we make the assumption that none of the VTEs occurred in the injection/aspiration subjects and remove them from the sample number, the rate of VTE could increase to near 0.55%, which is not a small amount in regard to a clinically significant post-procedural sequela.

Although we would agree that a thorough review of the available medical literature would lead one to conclude that routine prophylaxis against VTE in foot and ankle surgery is not warranted, individual consideration should be given on a case-by-case basis. Although the authors acknowledge that they did not capture data on immobilization, probably the biggest risk factor for DVT,2-4 most of these forefoot surgeries would not require prolonged immobilization or non-weightbearing. The authors do note a few risk factors for development of VTE, including hormone replacement therapy or oral contraceptive pill use, history of VTE, or obesity, which are supported by previous literature.

Unfortunately, the authors’ conclusions cannot be generalized to “podiatric surgery.” It would be more appropriate for the title to be clarified: “The incidence and risk factors for VTE in selected forefoot procedures.”

Felcher AH, Mularski RA, Mosen DM, Kimes TM, DeLoughery TG, Laxson SE. Incidence and risk factors for venous thromboembolic disease in podiatric surgery. Chest. 2009;1354:917-922. [CrossRef] [PubMed]
 
Mizel MS, Temple HT, Michelson JD, et al. Thromboembolism after foot and ankle surgery. Clin Orthop Relat Res. 1998;348:180-185. [CrossRef] [PubMed]
 
Solis G, Saxby T. Incidence of DVT following surgery of the foot and ankle. Foot Ankle Int. 2002;235:411-414. [PubMed]
 
Slaybaugh RS, Beasley BD, Massa EG. Deep venous thrombosis risk assessment, incidence, and prophylaxis in foot and ankle surgery. Clin Podiatr Med Surg. 2003;202:269-289. [CrossRef] [PubMed]
 

Figures

Tables

References

Felcher AH, Mularski RA, Mosen DM, Kimes TM, DeLoughery TG, Laxson SE. Incidence and risk factors for venous thromboembolic disease in podiatric surgery. Chest. 2009;1354:917-922. [CrossRef] [PubMed]
 
Mizel MS, Temple HT, Michelson JD, et al. Thromboembolism after foot and ankle surgery. Clin Orthop Relat Res. 1998;348:180-185. [CrossRef] [PubMed]
 
Solis G, Saxby T. Incidence of DVT following surgery of the foot and ankle. Foot Ankle Int. 2002;235:411-414. [PubMed]
 
Slaybaugh RS, Beasley BD, Massa EG. Deep venous thrombosis risk assessment, incidence, and prophylaxis in foot and ankle surgery. Clin Podiatr Med Surg. 2003;202:269-289. [CrossRef] [PubMed]
 
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