Venous Thromboembolism following Foot and Ankle Surgery: A Retrospective Review with a Prospective Cohort Study Emphasizing the need for a Chemoprophylaxis Protocol.

Abstract

Venous thromboembolism (VTE) is a potentially fatal complication following surgery. Incidence rates vary significantly depending on the procedure, ranging from 45-57% after pelvic surgery to 0.22-5.09% after foot surgery. Because of this variability, the use of prophylaxis in foot and ankle surgery has been debated. This study aimed to evaluate the incidence of VTE in forefoot and rearfoot procedures and assess whether a patient-specific prophylaxis protocol reduced risk. Retrospective and prospective cohort study conducted over a four-year period. Patients were divided into two cohorts. In Period 1 (retrospective), patients did not receive prophylaxis. In Period 2 (prospective), patients were managed with a standardized protocol incorporating chemoprophylaxis and mechanical pneumatic compression based on patient-specific risk factors. A total of 1305 patients were included: 342 in Period 1 (174 forefoot, 168 rearfoot) and 963 in Period 2 (719 forefoot, 244 rearfoot). VTE incidence rates were calculated for each group. This study highlights the importance of distinguishing forefoot from rearfoot surgery when evaluating VTE risk. There were six occurrences of VTE following rearfoot surgery without prophylaxis. The use of a risk factor-based prophylaxis protocol was associated with a marked reduction in VTE events, supporting objective risk stratification to guide prophylaxis decisions and improve patient outcomes. Level 3.