Assessment of compliance with DVT prophylaxis guidelines in orthopedic trauma in an East Indian population

Abstract

Background: Venous thromboembolism (VTE) remains a significant preventable cause of morbidity and mortality in orthopedic trauma patients. Despite established guidelines, compliance with VTE prophylaxis protocols is often suboptimal. This study assessed adherence to DVT prophylaxis guidelines in orthopedic trauma patients at a tertiary care center in Eastern India.

Methods: A prospective observational audit was conducted over three months involving 30 consecutive orthopedic trauma patients requiring operative management. Compliance with key process measures was evaluated based on NICE NG89 guidelines: VTE risk assessment within 24 hours of admission, prophylaxis initiation within 14 hours, 24-hour risk reassessment, appropriate agent selection, mechanical prophylaxis utilization, and inpatient dose administration.

Results: The mean age was 42.3±16.8 years, with 73.3% males. Initial VTE risk assessment was documented in 76.7% of patients, but only 26.7% underwent 24-hour reassessment. Pharmacological prophylaxis was appropriately prescribed in 89.3% of indicated patients; however, only 44.0% received it within the recommended 14-hour timeframe. Mechanical prophylaxis was utilized in 46.7% of patients, with significantly higher rates in ICU admissions (100%) versus ward patients (27.3%, p<0.001). Inpatient dose compliance was 87.6%, with 48.0% of patients missing at least one dose. Complete guideline-concordant care was achieved in only 13.3% of patients. One symptomatic DVT occurred (3.3%) with no major bleeding complications.

Conclusion: Significant gaps exist in VTE prophylaxis compliance, particularly in 24-hour reassessment, timely initiation, and mechanical prophylaxis use. Targeted quality improvement interventions including structured documentation, automated reminders, and staff education are needed to optimize prophylaxis delivery in orthopedic trauma patients.