Incidence, Predictors and Outcome of Venous Thromboembolism Among Patients Undergoing Major Operation at Bugando Medical Centre. Mwanza, Tanzania
Allen Gabriel Kangalawe [Male]
Incidence, Predictors and Outcome of Venous Thromboembolism Among Patients Undergoing Major Operation at Bugando Medical Centre. Mwanza, Tanzania - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 2020 - xii; 87 Pages Includes References and Appendices
Abstract:
Background: Venous thromboembolism (VTE) is a disorder that includes deep venous thrombosis and pulmonary embolism. This study aimed to determine the incidence, predictors, and outcome of venous thromboembolism among patients undergoing major operations at Bugando Medical Centre.
Methods: Longitudinal study was conducted in the department of surgery at Bugando Medical Centre from February to July 2020. We recruited 400 patients undergoing major surgery, all study participants were screened for VTE using modified Caprini for DVT and modified Wells score for PE. Patients with high score from Caprini and Wells score were subjected to doppler ultrasonography and computerized tomography pulmonary angiography to confirm the diagnosis. Patient who had sudden death prior to these investigations underwent postmortem to confirm the diagnosis. Data were analyzed using STATA version 13.A p-value of <0.05 was significant
Results: The cumulative incidence of VTE was 11.8% with median age of 38 [IQR, 28-61] years. Age ≥45 years, body mass index ≥25, hypertension and prolonged duration of immobilization were the main predictors of VTE. Among 381 patients’ (43.0%, n=164) patients were postoperatively classified as having a high risk of developing VTE. Of these, (27.7%, n=45) developed VTE (fisher’s exact p<0.001). Out of 45 patients with VTE, 14 patients’ died resulting in a mortality rate of 31.1%. Mortality was associated with male gender (X2=6.1329, P=0.013). Only (17.7%, n=29) of high-risk patients received VTE prophylaxis, however, prophylaxis was protective against development of VTE (fisher exact P=0.023) which was statistically significant.
Conclusion: The study has demonstrated that VTE is not uncommon among postoperative patients at BMC and is associated with high mortality rate. At Bugando Medical Center, VTE prophylaxis is significantly underutilized. Therefore, implementation of appropriate prophylaxis measures to all patients at risk of developing VTE is of paramount importance in order to lower the risk of VTE.
= OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Outcome of surgery: was defined as patients with radiological and/or clinical evidence VTE (i.e. DVT or PE or both) and death following a major surgery. OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Duration of surgery: Is the total time between (cutting time) knife to skin, to the closure of skin, and for endoscopic surgery is the time duration from introduction of scope to the patient and removal of scope from the patient after completing the surgery OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Major surgery/operation: Is any open or laparoscopic intervention occurring in operating theatre requiring regional or general anaesthesia lasting more than 45minutes associated with an expected blood loss >500mls, at least one night of admission in hospital, opening of body cavity, resection of organ, extensive soft tissue resection or manipulation, joint replacement, open reduction and internal fixation and spine, thoracic, vascular or intracranial surgery. OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Pulmonary embolism: Is a dislodged blood clot from the deep veins in the lower extremities or pelvis which travels through the circulation and lodges into the pulmonary vessels and manifest with chest pain, difficulty in breathing, coughing +/-blood, fast breathing and heart rate, low blood pressure and fever occurring within 4 weeks or more after major operation. OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Deep vein thrombosis: Is a clinical and/or radiological presentation of the clotted blood in the deep veins of the lower extremities or pelvis occurring within 4 weeks or more following a major operation and manifest with unilateral or bilateral lower limb swelling, pain, tenderness, warm skin and bluish or reddish skin coloration around the affected area. OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Venous thromboembolism: Is a clinical and/or radiological presentation of the clotted blood in the deep veins of the lower extremities or pelvis with or without pulmonary manifestation, occurring within 4 weeks or more following a major operation. = ABBREVIATIONS AIDS Acquired Immunodeficiency Syndrome ASA American Association of Anesthesiologist BMC Bugando Medical Centre BMI Body Mass Index CREC CUHAS-BMC Research and Ethics Committee CTPA Computerized Tomography Pulmonary Angiography CUHAS Catholic University of Health and Allied Science CVD Cardiovascular Disease CXR Chest X-Ray DM Diabetes Mellitus DUS Doppler Ultrasonography DVT Deep Venous Thrombosis ECG Electrocardiogram EMD Emergency Medicine Department ENT Ear Nose and Throat GOPD Gynecological Outpatients Department HIV Human Immunodeficiency Virus IQR Interquartile Range LMWH Low Molecular Weight Heparin MOPD Medical Outpatients Department PE Pulmonary Embolism PI Principle Investigator SOPD Surgical Outpatients Department STATA South Texas Art Therapy Association UFH Unfractionated heparin US United States VTE Venous Thromboembolism
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : Website: www.bugando.ac.tz
--Surgery
Incidence, Predictors and Outcome of Venous Thromboembolism Among Patients Undergoing Major Operation at Bugando Medical Centre. Mwanza, Tanzania - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : 2020 - xii; 87 Pages Includes References and Appendices
Abstract:
Background: Venous thromboembolism (VTE) is a disorder that includes deep venous thrombosis and pulmonary embolism. This study aimed to determine the incidence, predictors, and outcome of venous thromboembolism among patients undergoing major operations at Bugando Medical Centre.
Methods: Longitudinal study was conducted in the department of surgery at Bugando Medical Centre from February to July 2020. We recruited 400 patients undergoing major surgery, all study participants were screened for VTE using modified Caprini for DVT and modified Wells score for PE. Patients with high score from Caprini and Wells score were subjected to doppler ultrasonography and computerized tomography pulmonary angiography to confirm the diagnosis. Patient who had sudden death prior to these investigations underwent postmortem to confirm the diagnosis. Data were analyzed using STATA version 13.A p-value of <0.05 was significant
Results: The cumulative incidence of VTE was 11.8% with median age of 38 [IQR, 28-61] years. Age ≥45 years, body mass index ≥25, hypertension and prolonged duration of immobilization were the main predictors of VTE. Among 381 patients’ (43.0%, n=164) patients were postoperatively classified as having a high risk of developing VTE. Of these, (27.7%, n=45) developed VTE (fisher’s exact p<0.001). Out of 45 patients with VTE, 14 patients’ died resulting in a mortality rate of 31.1%. Mortality was associated with male gender (X2=6.1329, P=0.013). Only (17.7%, n=29) of high-risk patients received VTE prophylaxis, however, prophylaxis was protective against development of VTE (fisher exact P=0.023) which was statistically significant.
Conclusion: The study has demonstrated that VTE is not uncommon among postoperative patients at BMC and is associated with high mortality rate. At Bugando Medical Center, VTE prophylaxis is significantly underutilized. Therefore, implementation of appropriate prophylaxis measures to all patients at risk of developing VTE is of paramount importance in order to lower the risk of VTE.
= OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Outcome of surgery: was defined as patients with radiological and/or clinical evidence VTE (i.e. DVT or PE or both) and death following a major surgery. OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Duration of surgery: Is the total time between (cutting time) knife to skin, to the closure of skin, and for endoscopic surgery is the time duration from introduction of scope to the patient and removal of scope from the patient after completing the surgery OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Major surgery/operation: Is any open or laparoscopic intervention occurring in operating theatre requiring regional or general anaesthesia lasting more than 45minutes associated with an expected blood loss >500mls, at least one night of admission in hospital, opening of body cavity, resection of organ, extensive soft tissue resection or manipulation, joint replacement, open reduction and internal fixation and spine, thoracic, vascular or intracranial surgery. OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Pulmonary embolism: Is a dislodged blood clot from the deep veins in the lower extremities or pelvis which travels through the circulation and lodges into the pulmonary vessels and manifest with chest pain, difficulty in breathing, coughing +/-blood, fast breathing and heart rate, low blood pressure and fever occurring within 4 weeks or more after major operation. OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Deep vein thrombosis: Is a clinical and/or radiological presentation of the clotted blood in the deep veins of the lower extremities or pelvis occurring within 4 weeks or more following a major operation and manifest with unilateral or bilateral lower limb swelling, pain, tenderness, warm skin and bluish or reddish skin coloration around the affected area. OPERATIONAL DEFINITIONS For the purposes of this study the following were defined as follows:- Venous thromboembolism: Is a clinical and/or radiological presentation of the clotted blood in the deep veins of the lower extremities or pelvis with or without pulmonary manifestation, occurring within 4 weeks or more following a major operation. = ABBREVIATIONS AIDS Acquired Immunodeficiency Syndrome ASA American Association of Anesthesiologist BMC Bugando Medical Centre BMI Body Mass Index CREC CUHAS-BMC Research and Ethics Committee CTPA Computerized Tomography Pulmonary Angiography CUHAS Catholic University of Health and Allied Science CVD Cardiovascular Disease CXR Chest X-Ray DM Diabetes Mellitus DUS Doppler Ultrasonography DVT Deep Venous Thrombosis ECG Electrocardiogram EMD Emergency Medicine Department ENT Ear Nose and Throat GOPD Gynecological Outpatients Department HIV Human Immunodeficiency Virus IQR Interquartile Range LMWH Low Molecular Weight Heparin MOPD Medical Outpatients Department PE Pulmonary Embolism PI Principle Investigator SOPD Surgical Outpatients Department STATA South Texas Art Therapy Association UFH Unfractionated heparin US United States VTE Venous Thromboembolism
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : Website: www.bugando.ac.tz
--Surgery