Postoperative venous thromboembolism risk-prediction in foot and ankle fracture surgery. 2023

Jane Brennan, and David Keblish, and Elizabeth Friedmann, and Adrienne Spirt, and Edward Holt, and Justin Turcotte
Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Annapolis, MD 21401, USA. Electronic address: jbrennan@luminishealth.org.

BACKGROUND Venous thromboembolism (VTE) are rare but serious complications after foot and ankle fracture surgery. A consensus definition of a high-risk patient has not been reached, leading to significant variability in the use of pharmacologic agents for VTE prophylaxis. The aim of this study was to develop a model for predicting VTE risk in patients undergoing surgery for foot and ankle fractures that is usable and scalable in clinical practice. METHODS A retrospective review of 15,342 patients, within the ACS-NSQIP database, who had undergone surgical repair of foot and ankle fractures from 2015 to 2019 was performed. Univariate analysis evaluated differences in demographics and comorbidities. Stepwise multivariate logistic regression was generated based on a 60 % development cohort to evaluate risk factors for VTE. A receiver operator curve based on the 40 % test cohort calculated area under the curve (AUC) to measure the accuracy of the model in predicting VTE within the 30-day postoperative period. RESULTS Of the 15,342 patients, 1.2 % patients experienced VTE, and 98.8 % patients did not. Patients who experienced VTE were significantly older and had an overall higher comorbidity burden. Those who had VTE spent on average 10.5 more minutes in the operating room. In the final model, age over 65, diabetes, dyspnea, CHF, dialysis, wound infection and bleeding disorders were all found to be significant predictors of VTE after controlling for all other factors. The model generated an AUC of 0.731, indicating good predictive accuracy. The predictive model is publicly available at https://shinyapps.io/VTE_Prediction/. CONCLUSIONS In alignment with previous studies, we identified increased age and bleeding disorders as independent risk factors for VTE after foot and ankle fracture surgery. This is one of the first studies to generate and test a model for identifying patients at risk for VTE in this population. This evidence-based model may help surgeons prospectively identify high-risk patients who may benefit from pharmacologic VTE prophylaxis.

UI MeSH Term Description Entries
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000842 Ankle The region of the lower limb between the FOOT and the LEG. Tarsus,Regio tarsalis,Ankles
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D054556 Venous Thromboembolism Obstruction of a vein or VEINS (embolism) by a blood clot (THROMBUS) in the blood stream. Thromboembolism, Venous
D035002 Lower Extremity The region of the lower limb in animals, extending from the gluteal region to the FOOT, and including the BUTTOCKS; HIP; and LEG. Extremity, Lower,Lower Limb,Membrum inferius,Extremities, Lower,Limb, Lower,Limbs, Lower,Lower Extremities,Lower Limbs
D064386 Ankle Fractures Fractures of any of the bones of the ANKLE. Bimalleolar Ankle Fractures,Bimalleolar Equivalent Ankle Fractures,Bimalleolar Equivalent Fractures,Bimalleolar Fractures,Lateral Malleolus Fractures,Medial Malleolus Fractures,Posterior Malleolus Fractures,Trimalleolar Ankle Fractures,Trimalleolar Fractures,Ankle Fracture,Ankle Fracture, Bimalleolar,Ankle Fracture, Trimalleolar,Bimalleolar Ankle Fracture,Bimalleolar Equivalent Fracture,Bimalleolar Fracture,Equivalent Fracture, Bimalleolar,Fracture, Ankle,Fracture, Bimalleolar,Fracture, Bimalleolar Ankle,Fracture, Bimalleolar Equivalent,Fracture, Lateral Malleolus,Fracture, Medial Malleolus,Fracture, Posterior Malleolus,Fracture, Trimalleolar,Fracture, Trimalleolar Ankle,Lateral Malleolus Fracture,Malleolus Fracture, Lateral,Malleolus Fracture, Medial,Malleolus Fracture, Posterior,Medial Malleolus Fracture,Posterior Malleolus Fracture,Trimalleolar Ankle Fracture,Trimalleolar Fracture

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