Are foot and ankle surgeons being made to guess when it comes to blood clots and pulmonary emboli?
“Yes,” says Christopher DiGiovanni, M.D., chief of the Division of Foot & Ankle Surgery at Massachusetts General Hospital and Newton Wellesley Hospital.
Dr. DiGiovanni told OTW, “As opposed to hip and knee replacement, foot and ankle surgery is sorely lacking when it comes to preventing blood clots in the legs or pelvis. These are potentially fatal events, and we foot and ankle surgeons are seriously lacking in data to help us guide patients and create a shared decision making model. All existing studies are not appropriately powered to render valid scientific conclusions; it has been this way for decades. In order to answer pertinent questions, we need a lot of patients and different study arms. Anyone will tell you that it’s a great idea…but no one wants to pay for it. The sad bottom line is that we have been making decisions on these patients using only level 4/5 evidence. There are patients being undertreated and overtreated…and by sheer luck some are being treated correctly.”