UK Foot and Ankle Thromboembolism (UK-FATE)

Area of Science:

• Orthopedic Surgery
• Vascular Surgery
• Clinical Audit

Background:

• Venous thromboembolism (VTE) is a known complication following foot and ankle surgery.
• Current guidelines lack consensus on risk factors and chemical prophylaxis for VTE in this patient population.
• Achilles tendon (TA) rupture is a specific condition often managed surgically or non-operatively.

Purpose of the Study:

• To determine the 90-day incidence of symptomatic VTE and VTE-related mortality after foot and ankle surgery and TA rupture.
• To evaluate the variability in chemical prophylaxis administration.
• To identify key risk factors predicting VTE development.

Main Methods:

• A multicentre, prospective national collaborative audit was conducted over nine months in UK hospitals.
• Data were collected for patients undergoing foot and ankle surgery or TA rupture treatment.
• Univariable and multivariable logistic regression models were employed to assess VTE risk factors and the association with thromboprophylaxis.

Main Results:

• 11,363 patients were analyzed; 99 cases of VTE (0.87% incidence) and 0.03% VTE-related mortality were recorded.
• Low-molecular-weight heparin was the most common anticoagulant, yet 32.71% of patients received no chemical prophylaxis.
• Increased age, higher American Society of Anesthesiologists (ASA) grade, and prior VTE history were associated with higher VTE odds. Foot and ankle procedure type and ASA grade were strongest predictors.

Conclusions:

• The 90-day incidence of symptomatic VTE and related mortality is low in patients undergoing foot and ankle surgery and TA rupture management.
• Significant variability exists in the chemical prophylaxis prescribed.
• Achilles tendon rupture and high ASA grade are significant risk factors for 90-day symptomatic VTE.