| المستخلص: |
BACKGROUND: Venous thromboembolism is an important complication of major orthopedic surgery, and associated with significant morbidity and mortality. Patients undergoing major orthopedic surgery, such as knee or hip arthroplasty, are at high risk or very high risk of venous thromboembolism; hence, current management guidelines recommend that thromboprophylaxis should be used routinely in such patients. Guidelines recommend thromboprophylaxis for at least 10 days to prevent venous thromboembolism in patients undergoing high-risk orthopedic surgery, such as total hip or knee arthroplasty. Furthermore, the recently updated ACCP guidelines also recommend extending the duration of thromboprophylaxis for 28-35 days following total hip replacement or hip fracture surgery as the risk of venous thromboembolism persists for up to 3 months after surgery. Despite the existence of national and international guidelines, it is clear that thromboprophylaxis is still inadequately used in orthopedic surgery patients. The Objectives of this study were to estimate the practical adherence to the published thromboprophylaxis guidelines, investigate the efficacy of the currently used thromboprophylaxis protocol and determine the incidence of VTE post operatively and the risk factors behind it in patients undergoing major orthopedic surgery. Method: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between June of 2013 and June of 2014 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. Study was conducted in two hospitals in Khartoum state where major orthopedic surgery performed to look at the above mention objectives. Results: I reviewed the medical records of 179 patients. The proportions of knee arthroplasty, hip arthroplasty, femur fracture and were 41%, 19.6%, 34% respectively. 4 (2.2%) were diagnosed with DVT, Most of them developing DVT within 5 days post operatively. The mean age of the patients was 61.50 ±16.39 years. Male encountered 54.7% while female were 45.3%., in 178 (99.40%) patients enoxaparine was administered. 159 (88.80%) of the patients presented with one or more than one risk factors for VTE other than the orthopedic surgery. 4 (2%) of patients received thromboprophylaxis for more than 14 days while in 175 (98%) of the cases was administered for short term (3-5 days). The incidence of DVT was higher in diabetic patients (p= 0.03) and who aged ≥60 years. Conclusion: the results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should implement to a risk stratification model and an evidence based protocol and be aware of VTE, especially in elderly patients (≥ 60 years of age) who present with comorbidity and extend the Thromboprophylaxis duration in the high-risk patients.
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