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Original Research: VENOUS THROMBOEMBOLIC DISEASE |

Incidence and Risk Factors for Venous Thromboembolic Disease in Podiatric Surgery

Andrew H. Felcher, MD; Richard A. Mularski, MD, MSHS, MCR, FCCP; David M. Mosen, PhD, MPH; Teresa M. Kimes, MS; Thomas G. DeLoughery, MD; Steven E. Laxson, DPM
Author and Funding Information

*From Northwest Permanente Medical Group (Drs. Felcher and Laxson), Portland, OR; The Center for Health Research, Kaiser Permanente Northwest (Drs. Mularski and Mosen, and Ms. Kimes), Portland, OR; and Oregon Health and Sciences University (Dr. DeLoughery), Portland, OR.

Correspondence to: Richard A. Mularski, MD, MSHS, MCR, FCCP, Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, WIN1060, Portland, OR 97227; e-mail: richard.a.mularski@kpchr.org


This study was supported by a grant from Kaiser Permanente Northwest Community Benefit Investment. The Kaiser Permanente Northwest Community Benefit Investment supports collaboration between clinical investigators from Northwest Permanente Medical Group and the Center for Health Research.

Dr. DeLoughery receives grant support or honoraria from GlaxoSmithKline, Aventis, and Baxter. The other authors have no conflicts of interest to disclose.

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

For editorial comment see page 888


Chest. 2009;135(4):917-922. doi:10.1378/chest.08-1631
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Background:  The Agency for Healthcare Research and Quality ranks prevention of venous thromboembolism (VTE) as a top priority for patient safety; however, no guidelines or population-based research exist to guide management for podiatric surgery patients. The objective of our study was to determine the incidence and risk factors for postprocedure VTE in podiatric surgery.

Methods:  A 5-year retrospective analysis of patients undergoing podiatric surgery in a large not-for-profit health maintenance organization serving > 485,000 members in the Pacific Northwest from 1999 to 2004.

Results:  We identified 16,804 surgical procedures in 7,264 patients and detected 22 symptomatic postprocedure VTEs. The overall incidence of postprocedure VTE was 0.30%. Three risk factors were significantly and independently associated with VTE in podiatric surgery: prior VTE (incidence, 4.6%; relative risk, 23.0; p < 0.001), use of hormone replacement therapy or oral contraceptives (incidence, 0.55%; relative risk, 4.2; p = 0.01), and obesity (incidence, 0.48%; relative risk, 3.0; p = 0.02).

Conclusions:  We identified a low overall risk of VTE in podiatric surgery, suggesting that routine prophylaxis is not warranted. However, for patients with a history of VTE, periprocedure prophylaxis is suggested based on the level of risk. For podiatry surgery patients with two or more risk factors for VTE, periprocedure prophylaxis should be considered. Until a prospective study is completed testing recommendations, guidelines and care decisions for podiatric surgery patients will continue to be based on retrospective data, expert consensus, and clinical judgment.

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