Évaluation des complications thromboemboliques veineuses chez les patients opérés de fractures du bassin

Abstract

IntroductionFractures of the pelvis (acetabulum and pelvic ring) are complex in both radiological diagnosis and therapeutic management. They show high risk of thrombosis, with variable rates of venous thromboembolic complications in the literature, ranging from 10% to 50%, with 0.5–10% risk of fatal pulmonary embolism. The objective of the present study was to determine the rate of venous thromboembolic events in a consecutive cohort of pelvic fracture and to attempt to identify thromboembolic risk factors in this population. Material and methodThe study was based on a continuous retrospective series of 120 patients operated on between January 2015 and January 2017. Standard demographic data, clinical and diagnostic data for the fracture and the surgical approach were collected. Risk factors for venous thrombotic episodes were identified on Greenfield Risk Assessment Profile items (age, BMI, cancer, history of venous thromboembolism, surgery time, transfusion, femoral venous catheter, associated fracture) to define groups with high or low thrombotic risk. ResultsThere was a 5% rate of venous thromboembolic events, and 2.5% of pulmonary embolism including 1 causing intraoperative death. The Greenfield score usually applied in surgery to assess venous thromboembolism risk did not seem relevant in this population already at high risk of venous thromboembolism. No additional independent risk factors were identified. ConclusionThis is the largest cohort focusing on thromboembolic risk in pelvic fracture. The results refine rates reported in the literature. A prospective study, currently underway, should highlight risk factors so as better to prevent these complications.