VENOUS THROMBOEMBOLISM PREVENTION PRACTICE AND ASSOCIATED FACTORS AMONG ORTHOPAEDIC SURGICAL PATIENTS AT UNIVERSITY OF GONDAR COMPRHENSIVE AND SPECIALIZED HOSPITAL, GONDAR, ETHIOPIA: A CROSS-SECTIONAL STUDY

Abstract

Abstract Background: Venous thromboembolism includes deep vein thrombosis and pulmonary embolism. It is the 3 rd leading cause of death from cardiovascular causes after myocardial infarction and stroke. There is established evidence of cost effectiveness of preventing venous thromboembolism. Moreover, there are different guidelines on the prevention of venous thromboembolism however prevention practice in Ethiopia is not well studied in orthopaedic surgery patients. Objectives: To evaluate the prevention practice of venous thromboembolism and its associated factors among orthopaedic surgery patients at university of Gondar comprehensive and specialized Hospital Method: A hospital based cross-sectional study was conducted among systematically selected orthopaedics surgery patients. A Caprini risk assessment model was used to identify risk factors. American college of chest physician 2012 VTE guideline was used to determine appropriateness of prevention practice. Data were collected by interview, reviewing medical records using structured and pretested questionnaire. Collected data was entered using Epidata 7 and exported to SPSS version 25. Variables having association in the bivariate logistic

regression (p<0.25) was entered to multivariate logistic

regressions model and p value ?0.05 were used to claim statistical significance. Result: From a total of 375 study subjects majority (88.3%) were males and the mean age was 29 ± 10.4 years. The mean venous thromboembolism risk score was 7.7± 2.9. Of these 309 patients who have indication to receive venous thromboembolism prophylaxis, only 122 (39.4%) received pharmacologic prevention practice. Unfractionated heparin was the most widely used thromboprophylaxis regimen. Overall less than half (46.4%) of participants were received appropriate venous thromboembolism prevention practice. Multivariable logistic regression analysis revealed that having a restricted type of physical activity [AOR=9.73 (95% CI 2.0-45.7, p= 0.004)], being bed ridden [AOR= 8.86 (95%CI 2.0-39.2, p= 0.01)] and having ASA classification score of >3 [AOR= 9.6 (95% CI 1.7-52.1, p=0.009)] were associated with inappropriate VTE prevention practice. Conclusion: Despite the majority of patients at orthopaedic surgical patients were at risk of developing venous thromboembolism, prevention practices remains underutilized at university of Gondar comprehensive and specialized hospital. Hence, a concerted effort has to be made to reduce contributing factors and improve utilization of thromboprophylaxis. Key words: Venous thromboembolism, pulmonary embolism, thromboprophylaxis, prophylaxis, orthopaedics, Gondar