Risk Factors of Venous Thromboembolism in Indian Patients with Pelvic-Acetabular Trauma

Abstract

Purpose. To determine risk factors of venous thromboembolism (VTE) in Indian patients undergoing surgery for pelvic-acetabular fractures. Methods. 48 men and 8 women aged 17 to 61 (mean, 36) years who underwent open reduction and internal fixation for pelvic-acetabular fractures were evaluated for VTE in the postoperative period. Pulmonary angiography and indirect computed tomographic venography were used in the hospital, whereas colour Doppler ultrasonography was used in an outpatient setting until postoperative week 6. Patients with evidence of VTE were treated according to the American College of Chest Physician guidelines. Correlations between VTE and putative variable were assessed, and risk factors determined. Results. 16 patients developed VTE. Six patients with proximal DVT had associated pulmonary embolism (PE). There were 12 cases of proximal deep vein thrombosis (DVT), 2 cases of distal DVT, and 10 cases of PE. The rate of VTE was significantly higher in patients who had predominantly posterior injury (as opposed to anterior injury) [13/27 vs. 3/29, p=0.003], who were operated on in the lateral position (as opposed to the supine position) [13/30 vs. 3/26, p=0.016], or via the Kocher-Langenbeck or combined approach (as opposed to others) [13/30 vs. 3/26, p=0.016]. Patients were more likely to develop VTE when they had predominantly posterior injuries (7.8 fold) or were operated on in a lateral position (2.96 fold) or via the Kocher-Langenbeck approach (2.27 fold). Conclusion. Pelvic-acetabular trauma is a significant risk factor for VTE, even in Indians. Patients who have posterior injuries or are operated on in the lateral position, or via the Kocher-Langenbeck approach have a significantly higher risk of VTE.