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Agrawal S, Sridhar S, Harrison M, Houchen-Wolloff L, Divall P, Mangwani J. Effect of co-morbidities on outcomes of first metatarsophalangeal joint fusion: A systematic review. J Orthop 2024; 58:29-34. [PMID: 39040136 PMCID: PMC11260351 DOI: 10.1016/j.jor.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 06/22/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction The pre-existing co-morbidities have a major impact on the outcomes of Orthopaedic procedures as shown by the several studied in various contexts. However, the specific influence of these co-morbidities on first metatarsophalangeal joint fusion remains relatively underexplored. This study aims to address this gap by examining the association between co-morbidities such as obesity, smoking, diabetes, advancing age, and rheumatoid arthritis, and the outcomes of first metatarsophalangeal joint fusion. Methods A comprehensive search was conducted across multiple databases, including MEDLINE, EMBASE, and CINAHL. Relevant articles were identified and processed using Covidence, with independent assessment conducted to ensure inclusion criteria were met. The focus of the review was on analysing the effects of specific co-morbidities on fusion outcomes. Results Seven qualifying studies were identified for full-text extraction, revealing significant heterogeneity across the literature, which hindered direct statistical comparisons. The findings presented inconclusive effects of obesity on fusion outcomes, with ambiguous impacts observed for diabetes mellitus and smoking. Additionally, no discernible variance was observed in functional outcomes across different age groups. Furthermore, steroid usage in rheumatoid arthritis cases demonstrated delayed fusion in revision procedures, while primary outcomes remained uncertain. Conclusion This systematic review highlights the need for further research with standardised methodologies to better understand the correlation between pre-existing co-morbidities and outcomes in first metatarsophalangeal joint fusion. By elucidating these relationships, clinicians can better tailor treatment approaches and optimise patient care in this specific Orthopaedic context. Level of evidence Level III.
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Affiliation(s)
- Somen Agrawal
- Department of Orthopaedic Surgery University Hospital Coventry and Warwickshire, Clifford Bridge Rd, Coventry, CV2 2DX, United Kingdom
| | - Sumedh Sridhar
- Leicester Medical School, University Road, Leicester, LE1 7RH, United Kingdom
| | - Matt Harrison
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, United Kingdom
| | - Linzy Houchen-Wolloff
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, United Kingdom
| | - Jitendra Mangwani
- Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, United Kingdom
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Webb AR, Manz WJ, Fuqua A, Coleman MM, Bariteau JT, Kadakia RJ. Effect of Obesity on Patient-Perceived Outcomes After First Metatarsophalangeal Joint Arthrodesis. Foot Ankle Spec 2024; 17:58-66. [PMID: 36124436 DOI: 10.1177/19386400221118894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While first metatarsophalangeal joint (MTPJ) arthrodesis is a common and effective procedure, there is a paucity of studies examining obesity's effect on outcomes of 1st MTPJ arthrodesis. This study's purpose was to evaluate patient-reported outcomes following 1st MTPJ arthrodesis in obese versus non-obese patients. METHODS A retrospective cohort study of 94 patients undergoing first MTPJ fusion over the age of 18 with a diagnosis of hallux valgus or hallux rigidus was performed. Surgical and postoperative outcomes were examined preoperatively and at 6 and 12 months follow-up via Visual Analog Pain scale (VAS), and Short Form 36 (SF-36) surveys, and data were stratified into 2 patient groups: BMI < 30 (n = 62, mean age 63.9 ± 9.1 and ≥ 30 (n = 32, mean age 61.9 ± 8.4). RESULTS Average overall VAS and SF-36 physical component scores improved significantly at 6 months (P < .001, .006) and 1 year postoperative visits (P < .001, .007) with no differences in survey scores, outcomes, or complications between weight groups. CONCLUSION Our study showed first MTPJ fusion improves short-term pain and physical quality-of-life in arthritic obese and non-obese patients without differences in nonunion, complications, or patient-reported measures. LEVEL OF EVIDENCE Level III, Prognostic, Case-Control Study.
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Affiliation(s)
- Alex R Webb
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Wesley J Manz
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Andrew Fuqua
- Emory University School of Medicine, Atlanta, Georgia
| | - Michelle M Coleman
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Jason T Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Rishin J Kadakia
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
- Department of Orthopaedics, Emory University, Atlanta, Georgia
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Zambelli R, Frölke S, Nery C, Baumfeld D, Ortiz C, Cannegieter S, Nemeth B, Rezende SM. Venous Thromboembolism Prophylaxis in Foot and Ankle Surgery: A Worldwide Survey. J Foot Ankle Surg 2024; 63:59-63. [PMID: 37661018 DOI: 10.1053/j.jfas.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/09/2023] [Accepted: 08/26/2023] [Indexed: 09/05/2023]
Abstract
Current recommendations on thromboprophylaxis for foot and ankle (FA) surgery are often inconsistent and generally based on weak evidence. The aim of this survey study was to evaluate the current practice among orthopedic surgeons regarding venous thromboembolism (VTE) prophylaxis following FA surgery. From February 2019 to March 2020, an online questionnaire was sent by e-mail to orthopedic societies across the world. The questionnaire was hosted by the International Society of Thrombosis and Haemostais RedCAP platform. Topics of interest were VTE rates following FA surgery, duration and type of thromboprophylaxis, bleeding complications, VTE risk factors for prophylaxis and use of risk assessment. A total of 693 FA orthopedic surgeons from all continents completed the survey of whom 392 (57%) performed more than 200 FA procedures per year. A total of 669/693 (97%) respondents stated that thromboprophylaxis is necessary in FA surgeries. When thromboprophylaxis was prescribed, half of surgeons prescribed it for the duration of immobilization. Acetylsalicylic acid, low molecular weight heparin and direct-oral anticoagulants were, in this order, the preferred choice. Acetylsalicylic acid and low molecular weight heparin were predominantly prescribed in North America and Europe, respectively. Previous deep vein thrombosis, immobility, obesity and inherited thrombophilia were considered the main risk factors indicative of thromboprophylaxis use. In this survey, most surgeons agree that thromboprophylaxis is indicated for FA surgery, but the prescription, type and duration of prophylaxis differs greatly with a large intercontinental discrepancy. These survey results could be a foundation for developing uniform guidelines to optimize thromboprophylactic strategies in FA procedures around the world.
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Affiliation(s)
- Roberto Zambelli
- Department of Orthopaedic Surgery, Mater Dei Healthcare Network, Belo Horizonte, Minas Gerais, Brazil; Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Surgery, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sophie Frölke
- Renal Transplant Unit, Department of Internal Medicine, University Medical Center, University of Amsterdam
| | - Caio Nery
- Foot and Ankle Clinic, Albert Einstein Jewish Hospital, São Paulo, Brazil
| | - Daniel Baumfeld
- Orthopedic Department, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cristian Ortiz
- Foot and Ankle Surgery, Clínica U de Los Andes, Santiago, Chile
| | - Suzanne Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Banne Nemeth
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Orthopaedic Surgery, Leiden University Medical Center, The Netherlands
| | - Suely Meireles Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Gouzoulis MJ, Joo PY, Kammien AJ, McLaughlin WM, Yoo B, Grauer JN. Risk factors for venous thromboembolism following fractures isolated to the foot and ankle fracture. PLoS One 2022; 17:e0276548. [PMID: 36264985 PMCID: PMC9584400 DOI: 10.1371/journal.pone.0276548] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Venous thromboembolism (VTE) is an uncommon, but potentially morbid, complication following foot and ankle fractures. Current standard is to not administer thromboprophylaxis to patients with such injuries. Nonetheless, patient and fracture factors might affect this risk/benefit consideration. The goal of this study was to determine what patients are most at risk. METHODS The M53Ortho Pearldiver database was used to identify patients with fractures isolated to the foot and ankle that were treated non-operatively or operatively. Patients with pilon, other appendicular fractures remote from the foot and ankle, and other traumatic injuries were excluded. The 90-day occurrence of VTE was identified based on codes for deep vein thrombosis or pulmonary embolism. Characteristics of those patients who did and did not have VTEs were compared using chi-square analyses. Multivariate logistical regression was then performed to determined factors independently associated with VTE. Finally, timing of VTE relative to fracture was analyzed. RESULTS A total of 298,886 patients with isolated foot or ankle fractures were identified, of which 1,661 (0.56%) had VTE in the 90 days following fracture. In terms of timing, 27.3% occurred in the first week, and 49.8% occurred in the first three weeks. Independent risk factors for VTE included (in decreasing order):prior VTE (odd ratio [OR] = 25.44), factor V Leiden (OR = 24.34), active cancer (OR = 1.84), specific fracture relative to metatarsal fracture (multiple fractures [OR: 1.51], ankle fracture [OR = 1.51], and calcaneus fracture [OR = 1.24]), surgical treatment (OR = 1.41), male sex (OR = 1.19), greater Elixhauser index (OR = 1.05), and increasing age (OR:1.05 per decade) (p<0.05 for each). CONCLUSIONS The present study found that, although only 0.56% of isolated foot and ankle fractures had a VTE within ninety days. Defined risk factors, such as Factor V Leiden, prior VTE, surgical treatment, active cancer, specific fracture patterns, and surgical treatment significantly affected the odds of their occurrence.
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Affiliation(s)
- Michael J. Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Peter Y. Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Alexander J. Kammien
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - William M. McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Brad Yoo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
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Traven SA, Farley KX, Gottschalk MB, Goodloe JB, Woolf SK, Xerogeanes JW, Slone HS. Combined Oral Contraceptive Use Increases the Risk of Venous Thromboembolism After Knee Arthroscopy and Anterior Cruciate Ligament Reconstruction: An Analysis of 64,165 Patients in the Truven Database. Arthroscopy 2021; 37:924-931. [PMID: 33478778 DOI: 10.1016/j.arthro.2020.10.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/28/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To use the Truven MarketScan database to (1) report the incidence of venous thromboembolism (VTE), including deep vein thromboses (DVTs) and pulmonary embolism (PE), in patients undergoing simple knee arthroscopy and anterior cruciate ligament (ACL) reconstruction, and (2) evaluate combined oral contraceptive (COCP) use as a potential risk factor for VTE in patients undergoing knee arthroscopy. METHODS All female patients between the ages of 16 and 40 years undergoing knee arthroscopy and ACL reconstruction between 2010 and 2015 were identified in the MarketScan database. Patients were stratified by whether they had a documented pharmaceutical claim for COCP therapy, and the primary outcome was the risk of DVT and or PE within 90 postoperative days. RESULTS In total, 64,165 patients were identified for inclusion. While the overall incidence of VTE was low, patients taking COCPs had an increased risk of a DVT or PE compared with those not on COCPs (odds ratio [OR] 2.1, P < .001). When patients were analyzed by procedural subgroup (ACL reconstruction and simple knee arthroscopy), similar results held true. Furthermore, smoking and obesity had a synergistic effect when combined with COCPs use on the risk of VTE. Specifically, 3.1% of patients with obesity on COCPs (OR 3.1, P < .001) and 4.0% of smokers on COCPs (OR 4.3, P < .001) developed a postoperative VTE. CONCLUSIONS This study demonstrates that COCP use is associated with an increased risk for a symptomatic DVT or PE (1.70% and 0.27%, respectively) after knee arthroscopy and an increased risk for DVT, but not PE (1.80% and 0.23%, respectively), after ACL reconstruction. In addition, patients with multiple risk factors present such as tobacco use, obesity, and COCP use had odds ratios greater than the sum of the individual risk factors alone. LEVEL OF EVIDENCE level III prognostic cohort study.
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Affiliation(s)
- Sophia A Traven
- Medical University of South Carolina, Charleston, South Carolina.
| | | | | | - J Brett Goodloe
- Medical University of South Carolina, Charleston, South Carolina
| | - Shane K Woolf
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Harris S Slone
- Medical University of South Carolina, Charleston, South Carolina
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Zambelli R, Bastos MD, Rezende SM. Prophylaxis of Venous Thromboembolism in Ankle and Foot Surgeries. Rev Bras Ortop 2020; 56:697-704. [PMID: 34900096 PMCID: PMC8651438 DOI: 10.1055/s-0040-1715512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022] Open
Abstract
Venous thromboembolism (VTE) is among the most feared complications by orthopedists both for due to its potentially lethal outcome and the uncertainties related to its prevention. Despite the vast literature on VTE prevention in major orthopedic surgeries, little is known about it in ankle and foot procedures. In orthopedics, adequate thromboprophylaxis requires a careful assessment of the thrombotic and hemorrhagic risks based on the procedure to be performed, as well as and knowledge on anticoagulant agents. The presentis review has the goal of assessing the risk of developingdiscusses VTE risk assessment, the modalities of thromboprophylaxis modalities, and the drugs used, with an emphasis on foot and ankle surgeries.
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Affiliation(s)
- Roberto Zambelli
- Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.,Serviço de Ortopedia, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brasil
| | - Marcos de Bastos
- Assessoria de Políticas de Saúde e Informações (ASPASI), Hospital Governador Israel Pinheiro (HGIP), Instituto de Previdência dos Servidores do Estado de Minas Gerais (IPSEMG), Belo Horizonte, Minas Gerais, Brasil.,Faculdade da Saúde e Ecologia Humana (FASEH), Vespasiano, Minas Gerais, Brasil
| | - Suely Meireles Rezende
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
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Risk factors for symptomatic venous thromboembolism following surgery for closed ankle fractures: A case-control study. Foot Ankle Surg 2020; 26:681-686. [PMID: 31481323 DOI: 10.1016/j.fas.2019.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND We analyzed risk factors for venous thromboembolism (VTE) within 6 months after surgery for closed ankle fractures. METHODS This was a case-control study based on data from chart review in a cohort of patients having open reduction and internal fixation (ORIF) for closed ankle fractures in two large general hospitals 2009-2011. Cases with symptomatic VTE (pulmonary embolism or deep venous thrombosis) were identified in the cohort, and additional cases of VTE were identified by computerized search of discharge diagnoses in the same hospitals in 2004-2008 and 2012-2016. In total, we identified 60 cases with VTE and compared with 240 randomly selected controls among 998 patients without VTE in the cohort. Risk factors were assessed using logistic regression analysis. RESULTS Among cases, 27 (45%) had pulmonary embolism, 33 (55%) deep venous thrombosis. Those with VTE were older, had higher BMI, had more often a family history of VTE, and more often had antibiotic prophylaxis during surgery than controls. In multivariable logistic regression analysis age/10 (OR 25.75, 95%CI 3.52-188.44, p=0.001), (age/10)2 (OR 0.77, 95%CI 0.65-0.93, p=0.005), BMI (1.15 per kg/m2, 95%CI 1.07-1.24, p<0.001) and Charlson comorbidity index ≥2 vs.0 (OR 0.27, 95%CI 0.08-0.92, p=0.036) and 1 vs. 0 (OR 0.27, 95%CI 0.09-0.86, p=0.026) were associated with VTE within 6 months of surgery. CONCLUSIONS The odds of symptomatic VTE within 6 months of ORIF increased with increasing age and BMI, but were lower with increasing comorbidity.
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Adamson P, Peters W, Janney C, Panchbhavi V. The safety of foot and ankle procedures at an ambulatory surgery center. J Orthop 2020; 21:203-206. [PMID: 32273657 DOI: 10.1016/j.jor.2020.03.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022] Open
Abstract
Background This study evaluates the safety of foot and ankle outpatient surgeries at a freestanding ambulatory surgery centers. Methods A total of 1352 cases were evaluated for adverse events in a retrospective review of all foot and ankle cases performed over a 5-year period at a single center. Results The rate of adverse events was 2.3%, with 31 identified over the 5-year period (23 infections, 5 symptomatic thromboembolisms, 3 postoperative hospital transfers). Discussion The rate of postoperative adverse events in outpatient foot and ankle procedures is low. These surgeries can be performed safely in an outpatient setting at an ASC. Level of evidence Level IV, Case Series.
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Affiliation(s)
- Peter Adamson
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77550, USA
| | - Wesley Peters
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77550, USA
| | - Cory Janney
- Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 112, San Diego, CA, 92134, USA
| | - Vinod Panchbhavi
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77550, USA
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Hunter AM, Montgomery TP, Pitts CC, Moraes L, Anderson M, Wilson J, McGwin G, Shah A. Postoperative aspirin use and its effect on bone healing in the treatment of ankle fractures. Injury 2020; 51:554-558. [PMID: 31806383 DOI: 10.1016/j.injury.2019.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/17/2019] [Accepted: 11/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is hesitancy to administer nonsteroidal anti-inflammatories (NSAIDs) within the postoperative period following fracture care due to concern for delayed union or nonunion. However, aspirin (ASA) is routinely used for chemoprophylaxis of deep vein thrombosis (DVT) and is gaining popularity for use after treatment of ankle fractures. The current study examines the incidence of nonunion of operative ankle fractures and risk of DVT in patients who did and did not receive postoperative ASA. METHODS A retrospective chart review was performed on all patients treated between 2008 and 2018 for ankle fractures requiring operative fixation by three Foot and Ankle fellowship trained orthopaedic surgeons at a single institution. Demographics, preoperative comorbidities, and postoperative medical and surgical complications were compared between patients who did and did not receive ASA postoperatively. For both groups, union was evaluated by clinical exam as well as by radiograph, for those with 6-week, 12-week, or 24-week follow-up. RESULTS Five-hundred and six patients met inclusion criteria: 152 who received ASA and 354 who did not. Radiographic healing at six weeks was demonstrated in 95.9% (94/98) and 98.6% (207/210) respectively (p-value .2134). There was no significant difference in time to radiographic union between groups. The risk of postoperative DVTs in those with and without ASA was not significantly different (0.7% (1/137) vs 1.2% (4/323), respectively; p-value .6305). CONCLUSION Postoperative use of ASA does not delay radiographic union of operative ankle fractures or affect the rate of postoperative DVT. This is the first and largest study to examine the effect of ASA on time to union of ankle fractures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Allison M Hunter
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tyler P Montgomery
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Charles C Pitts
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Leonardo Moraes
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew Anderson
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - John Wilson
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, United States.
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Venous thromboembolism following foot and ankle surgery: A case series of two tertiary medical centers and a review of the literature. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Warren JA, Sundaram K, Hampton R, Billow D, Patterson B, Piuzzi NS. Venous thromboembolism rates remained unchanged in operative lower extremity orthopaedic trauma patients from 2008 to 2016. Injury 2019; 50:1620-1626. [PMID: 31519436 DOI: 10.1016/j.injury.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/02/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a serious complication that contributes to morbidity, mortality, and healthcare costs during the surgical care of patient with lower extremity fractures. Despite this, few recommendations on the topic exist and the literature on VTE incidence is incomplete. Therefore, this study will attempt to estimate annual incidence and trends in 30-day thrombotic events and mortality for the following fractures: (1) hip, (2) femur, (3) patella, (4) tibia and/or fibula, and (5) ankle. METHODS We identified 120,521 operative lower extremity orthopaedic trauma patients from 2008 to 2016 using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. To evaluate the relationship between the year in which surgery was performed and comorbidities and demographic information bivariate analysis was performed. Bivariate analysis was also performed for the outcomes of interest and year in which the surgery was performed to assess for change. Additionally, bimodal multivariate logistic regression models for hip, femur, and ankle fractures were built, comparing the years 2009 to 2016 using 2008 as a baseline. RESULTS Overall incidence for VTE over the study period was 1.7% for hip fractures, 2.4% for femur fractures, 0.9% for patella fractures, 1.1% in tibia and/or fibula fractures, and 0.6% in ankle fractures. Over the study period VTE incidence saw a significant decrease (p < 0.05) in hip and femur fractures, but not for patella, tibia and/or fibula, and ankle fractures. After adjusting for confounding factors with multivariate analysis, the change in hip and femur fractures was no longer significant, while no significant decrease was again found for ankle fractures (p > 0.05). CONCLUSION Our study demonstrates that VTE rates have remained unchanged in operative lower extremity orthopaedic trauma from 2008 to 2016. This highlights the need for higher quality evidence on this important topic in orthopaedic trauma, including a reevaluation on the necessity of thromboprophylaxis guidelines. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jared A Warren
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue/A41, Cleveland, OH, 44195, United States.
| | - Kavin Sundaram
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue/A41, Cleveland, OH, 44195, United States.
| | - Robert Hampton
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue/A41, Cleveland, OH, 44195, United States.
| | - Damien Billow
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue/A41, Cleveland, OH, 44195, United States.
| | - Brendan Patterson
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue/A41, Cleveland, OH, 44195, United States.
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue/A41, Cleveland, OH, 44195, United States.
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Incidence and Risk Factors for Venous Thromboembolism Following Hip Arthroscopy: A Population-Based Study. Arthroscopy 2019; 35:2380-2384.e1. [PMID: 31395174 DOI: 10.1016/j.arthro.2019.03.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the incidence of symptomatic venous thromboembolism (VTE) after hip arthroscopy (HA) using a large national database while considering several patient demographic factors. METHODS Patients ≥20 years old who underwent HA between 2007 and 2017 were identified within the Humana administrative claims database using relevant Current Procedural Terminology and International Classification of Diseases Ninth and Tenth Revision codes. Basic demographics, including age, gender, obesity (body mass index ≥ 30 kg/m2), oral contraceptive use, smoking history, diabetes, and chronic obstructive pulmonary disease (CLD) were recorded. Postoperative incidence of deep vein thrombosis, pulmonary embolism, and VTE was identified at 30 and 90 days postoperatively. Multivariate logistic regression analysis was performed to identify independent risk factors for VTE after HA, with statistical significance set at P < .05. RESULTS Overall, 9,477 patients underwent HA procedures over the study period, of whom 5,085 (53.7%) were female. The overall incidence of VTE in all patients was 0.77% (n = 73) and 1.14% (n = 108) at 30 and 90 days, respectively. Multivariate analysis identified age ≥ 45 (odds ratio [OR] = 1.82; 95% confidence interval [CI], 1.36-2.49; P = .0001), obesity (OR = 1.54; 95% CI, 1.27-1.86; P < .0001), smoking (OR = 1.26; 95% CI, 1.04-1.53; P = .0177), diabetes (OR = 1.59; 95% CI, 1.32-1.92; P < .0001), and CLD (OR = 2.10; 95% CI, 1.63-2.68; P < .0001) as independent risk factors for higher incidence of VTE after HA. However, neither gender nor oral contraceptive use were risk factors for VTE after HA. CONCLUSIONS For patients undergoing HA, the incidence of symptomatic postoperative VTE is low. This study identified age ≥45, obesity, tobacco use, diabetes, and CLD as independent risk factors for VTE after HA. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Huntley SR, Abyar E, Lehtonen EJ, Patel HA, Naranje S, Shah A. Incidence of and Risk Factors for Venous Thromboembolism After Foot and Ankle Surgery. Foot Ankle Spec 2019; 12:218-227. [PMID: 29682981 DOI: 10.1177/1938640018769740] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Samuel R Huntley
- Department of Surgery, Division of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama
| | - Eildar Abyar
- Department of Surgery, Division of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama
| | - Eva J Lehtonen
- Department of Surgery, Division of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama
| | - Harshadkumar A Patel
- Department of Surgery, Division of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama
| | - Sameer Naranje
- Department of Surgery, Division of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama
| | - Ashish Shah
- Department of Surgery, Division of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama
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Richey JM, Ritterman Weintraub ML, Schuberth JM. Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery. Foot Ankle Int 2019; 40:98-104. [PMID: 30192642 DOI: 10.1177/1071100718794851] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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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Affiliation(s)
- Johanna Marie Richey
- 1 Department of Orthopedic Surgery, Kaiser Antioch Medical Center, Antioch, CA, USA
| | | | - John M Schuberth
- 3 Department of Orthopedic Surgery, Kaiser San Francisco Medical Center, San Francisco, CA, USA
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