Venous thromboembolism following foot and ankle surgery: A retrospective review with a prospective cohort study emphasizing the need for a chemoprophylaxis protocol

BACKGROUND: 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. PURPOSE: This study aimed to evaluate the incidence of VTE in forefoot and rearfoot procedures and assess whether a patient-specific prophylaxis protocol reduced risk. STUDY DESIGN: Retrospective and prospective cohort study conducted over a four-year period. METHODS: 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. CONCLUSION: 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.