Incidence and associated factors of postoperative deep vein thrombosis among orthopedic patients in Northwest Ethiopia: a multicenter study highlighting thromboprophylaxis gaps in a low-resource setting

Deep vein thrombosis is a serious postoperative complication that may result in potentially fatal pulmonary embolism. Despite its clinical importance, evidence on the incidence, predictors, and thromboprophylaxis practices among orthopedic patients in Ethiopia is limited. This study aimed to determine the incidence and associated factors of deep vein thrombosis among orthopedic patients undergoing surgery in Northwest Ethiopia. A multicenter retrospective cohort study was conducted among postoperative orthopedic patients admitted at Tibebe Ghion Specialized Hospital and Felege Hiwot Comprehensive Specialized Hospital between January 1, 2019, and December 30, 2023. Data were extracted from the patients’ medical records. Multivariable logistic regression was applied to identify the independent predictors of postoperative deep vein thrombosis. The findings were reported using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). A p-value of <0.05 was considered statistically significant. Among 424 patients initially assessed, 409 were included in the final analysis, while 15 patients were excluded due to missing critical variables. Postoperative DVT was identified in 118 patients, yielding a proportion of 28.85% (95% CI: 24.50%–33.51%). Independent predictors of postoperative deep vein thrombosis include pelvic fracture (AOR = 4.89, 95% CI: 2.10–11.38; p < 0.001), femoral fracture (AOR = 4.15, 95% CI: 1.92–8.98; p < 0.001), underlying malignancy (AOR = 3.76, 95% CI: 1.34–10.54; p = 0.012), multiple or complex fractures (AOR = 2.11, 95% CI: 1.15–3.88; p = 0.016), coexisting disease (AOR = 1.98, 95% CI: 1.12–3.52; p = 0.019), postoperative immobilization lasting more than 7 days (AOR = 2.51, 95% CI: 1.44–4.38; p < 0.001), and pharmacological thromboprophylaxis (AOR = 0.35, 95% CI: 0.20–0.61; p < 0.001). The incidence of deep vein thrombosis among postoperative orthopedic patients was high. Pelvic bone fractures, femoral fractures, underlying malignancy, multiple or complex fractures, coexisting disease, and postoperative immobilization were independent predictors of deep vein thrombosis. Patients with these factors require structured perioperative venous thromboembolism risk assessments, early mobilization, and close postoperative monitoring to reduce the burden of postoperative deep vein thrombosis.