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- Author or Editor: Richmond Robinson x
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INTRODUCTION AND OBJECTIVES: The purpose of this study was to determine whether some foot/ankle surgeries would benefit from routine use of low molecular weight heparin (LMWH) as postoperative DVT prophylaxis.
METHODS: We conducted a formal cost-effectiveness analysis using a decision analytic tree to represent the risk of complications under a scenario of no prophylaxis and a scenario of routine LMWH prophylaxis for 4 weeks. The two scenarios were compared for five procedures: 1) Achilles tendon repair (ATR), 2) total ankle replacement (TAR), 3) hallux valgus surgery (HVS), 4) hindfoot arthrodesis (HA), and 5) ankle fracture surgery (AFS). Outcomes assessed included short and long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. Costs were evaluated from the health care system perspective and expressed in US dollars at a 2015 price base. In the short-term, routine prophylaxis was always associated with greater costs compared to no prophylaxis.
RESULTS: For ATR, TAR, HA and AFS prophylaxis was associated with slightly better health outcomes; however, the gain in QALYs was minimal compared to the cost of prophylaxis (ICER was well above $50,000/QALY threshold). For HVS, prophylaxis was associated with both worse health outcomes and greater costs. In the long-term, routine prophylaxis was always associated with worse health outcomes.
CONCLUSIONS: We conclude that the decision to use LMWH prophylaxis should not be based solely on the type of foot/ankle surgery planned. Patient factors also need to be carefully weighed.
Interprofessionalism
A Cornerstone of Innovation and Medical Education at Scholl College of Podiatric Medicine
In 1912, the Illinois College of Chiropody and Orthopedics was founded, and is today known as the Dr. William M. Scholl College of Podiatric Medicine. It has been an integral part of Rosalind Franklin University of Medicine and Science in North Chicago, Illinois since 2001. Through the ensuing decades, Scholl College alumni have been instrumental in moving the profession forward.
