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Low postoperative DVT or PE risk seen in patients following ankle fracture surgery
DVT, PE readmission rate was higher in study for older patients and those with comorbidities.
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Prophylaxis for thromboembolism in patients undergoing surgery for ankle fractures may only be indicated for high-risk patients who are older than age 50 or have peripheral vascular disease, according to findings from a large-scale database study.
Michael Eagan, MD, presented results from the research group of senior investigator, Nelson F. Soohoo, MD, which found a less than 1% readmission rate for pulmonary embolism (PE) and deep venous thrombosis (DVT) in an ankle fracture surgical population.
“Age, open fracture and medical comorbidity are associated with a statistically significant increase in the risk of PE, and age and peripheral vascular disease are associated with increased risk for DVT,” Eagan said at the American Academy of Orthopaedic Surgeons 2009 annual meeting.
Statewide database
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Image: SooHoo NF |
Soohoo and colleagues used the 1999 to 2005 admission/discharge records in California’s statewide patient database to identify individuals who had surgery for an ankle fracture.
The study included nearly 57,000 patients at a mean age 52 years with lateral malleolar, bimalleolar or trimalleolar fractures treated by open reduction internal fixation. The majority of those studied were women.
To draw their conclusions, researchers studied: fracture pattern, if the fractures were open or closed, age, gender, patient ethnicity, type of insurance utilized and presence of comorbidities, such as peripheral vascular disease (PVD) or diabetes mellitus.
Comorbidities
Researchers performed a multivariate logistic regression statistical analysis to determine the risk for DVT or PE.
Eagan said among those readmitted within 90 days, two groups were at increased risk for DVT were patients over age 50 and those with PVD.
Three groups were at significant risk of PE — those with open ankle fractures, older than age 50 or with a higher Charlson comorbidity index.
Limitations
He said the study’s limitations were the chance the database may have contained coding and data entry errors and that investigators did not know whether prophylaxis methods were used.
He noted these data suggest the routine use of prophylaxis following ankle fracture surgery may not be needed, however it may be indicated in the high-risk groups identified.
Session moderator Kenneth A. Egol, MD, told Orthopedics Today after the meeting that while Eagan’s paper presents important information, it only included patients with symptomatic DVT or PE requiring readmission to the hospital.
Higher incidence
“The actual incidence may be much higher, but either [they] do not need readmission for treatment or are asymptomatic. The identification of high-risk groups will help target intervention appropriately,” Egol said.
Orthopedics Today Editorial Board member Ronald W. Smith, MD, explained the consensus among foot and ankle orthopedic surgeons is that pharmacological DVT prophylaxis is rarely warranted. “This study helps justify prophylaxis in open ankle fractures in patients over 50 years old or with PVD, but commonly these factors are not sufficient to warrant medical prophylaxis,” he said.
“Instructions on calf exercises in the early postoperative period may be helpful in preventing DVT,” Smith said.
For more information:Reference:
- Nelson F. Soohoo, MD, can be reached at the University of California Los Angeles School of Medicine, 10945 LeConte Ave., PVUB #3355, Los Angeles, CA 90095; 310-267-5299. He has no direct financial interest in any products or companies mentioned in this article.
- Kenneth A. Egol, MD, can be reached at Hospital for Joint Diseases, NYU Medical Center, 240 E. 18th St., New York, NY 10003; 212-598-3889; e-mail: Kenneth.Egol@nyumc.org. He has no direct financial interest in any products or companies mentioned in this article.
- Ronald W. Smith, MD, can be reached at Balance Orthopaedic Foot and Ankle Center, 2651 Elm Ave., Suite 205, Long Beach, CA 90806; 562-424-9444; e-mail: rsmith@memorialcare.org. He has no direct financial interest in any products or companies mentioned in this article.
- SooHoo NF, Eagan M, Krenek L, et al. Incidence and risk factors for thromboembolism following surgical treatment of ankle fractures. #235. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.