Venous thromboembolism in patients with traumatic pelvic and acetabular fractures: a retrospective cohort study.

BACKGROUND: Studies on venous thromboembolism (VTE) in patients with traumatic pelvic and acetabular fractures have shown variable epidemiology, risk factors and outcomes. METHODS: This retrospective study evaluated patients with traumatic pelvic and/or acetabular fractures who were admitted to a Level 1 trauma center in Riyadh, Saudi Arabia between January 2016 and December 2022. We compared patients who had VTE to those who did not. RESULTS: The study evaluated 437 patients with (median age: 37 years; 72.8% males). VTE occurred in 42 patients (9.6%), with deep-vein thrombosis and pulmonary embolism occurring at almost equal rates. Patients with VTE were older and more likely to receive tranexamic acid (16.7% vs. 9.9%, p = 0.06), red blood cell (26.2% vs. 13.2%, p = 0.02) and platelet (9.5% vs. 3.8%, p = 0.08) transfusions, and pelvic angioembolization (9.5% vs. 3.0%, p = 0.03). The most common associated injuries were chest injury (28.4%) and abdomen/pelvis injury (23.8%). Pharmacologic thromboprophylaxis was used in 94.1% of patients, predominantly enoxaparin. The significant predictors of VTE were age, admission to the intensive care unit (odds ratio 2.746, 95% confidence interval 1.041-7.240) and hospital length of stay. The timing of pharmacologic thromboprophylaxis was not significantly associated with VTE. Patients with VTE had similar hospital mortality compared with those without VTE (4.8% vs. 4.1%, respectively; p = 0.83) but stayed for a longer period in the hospital (median stay: 21.5 days vs. 12.0 days, respectively; p < 0.0001). CONCLUSIONS: VTE was diagnosed in almost 1 in 10 patients with traumatic pelvic and/or acetabular fractures. The need for admission to the intensive care unit, but not the timing of pharmacologic thromboprophylaxis, predicted VTE.