Postoperative Blood Clots Struck Nearly Three in Ten Orthopedic Surgery Patients in Northwest Ethiopia

More than a quarter of orthopedic surgery patients developed deep vein thrombosis after their operations at two major hospitals in Northwest Ethiopia, according to a multicenter retrospective cohort study published in BMC Musculoskeletal Disorders. Among 409 postoperative patients whose medical records were analyzed, 118 were identified as having postoperative deep vein thrombosis, a proportion of 28.85% with a 95% confidence interval of 24.50% to 33.51%.

Deep vein thrombosis is a serious postoperative complication that may result in potentially fatal pulmonary embolism. The authors note that despite this clinical importance, evidence on the incidence, predictors, and thromboprophylaxis practices among orthopedic patients in Ethiopia has been limited, which motivated the multicenter review of patient records across the five-year window.

The retrospective design carries important limitations that shape how the results should be read. Because the analysis is observational, the identified associations describe which factors were linked to thrombosis in this population; they do not by themselves establish causal relationships in the way a randomized trial could.

Using multivariable logistic regression to identify independent predictors, the study found that the type and extent of injury mattered substantially. Pelvic fracture was associated with roughly a fivefold increase in the odds of postoperative deep vein thrombosis (adjusted odds ratio 4.89, 95% CI 2.10 to 11.38; p < 0.001), and femoral fracture with a roughly fourfold increase (AOR 4.15, 95% CI 1.92 to 8.98; p < 0.001). Multiple or complex fractures were also independently associated with higher odds (AOR 2.11, 95% CI 1.15 to 3.88; p = 0.016), as were underlying malignancy (AOR 3.76, 95% CI 1.34 to 10.54; p = 0.012) and the presence of coexisting disease (AOR 1.98, 95% CI 1.12 to 3.52; p = 0.019).

Postoperative immobilization emerged as another significant factor. Patients whose immobilization lasted more than seven days had about two and a half times the odds of developing deep vein thrombosis compared with others in the cohort (AOR 2.51, 95% CI 1.44 to 4.38; p < 0.001).

The one protective factor identified was pharmacological thromboprophylaxis, the preventive use of clot-preventing medication. Patients who received it had substantially lower odds of postoperative deep vein thrombosis (AOR 0.35, 95% CI 0.20 to 0.61; p < 0.001), meaning the odds were roughly cut by about two-thirds in this retrospective analysis. The study’s title flags thromboprophylaxis gaps in this low-resource setting, and this inverse association is the quantitative basis for that emphasis, though the observational design means unmeasured differences between treated and untreated patients could contribute to the estimate.

The authors conclude that the incidence of deep vein thrombosis among postoperative orthopedic patients in this cohort was high, and that pelvic bone fractures, femoral fractures, underlying malignancy, multiple or complex fractures, coexisting disease, and postoperative immobilization were independent predictors. Their recommendation is that patients carrying these risk factors receive structured perioperative venous thromboembolism risk assessments, early mobilization, and close postoperative monitoring to reduce the burden of postoperative deep vein thrombosis.

For clinicians and health planners in similar low-resource settings, the study offers a quantified baseline: nearly 29% of postoperative orthopedic patients in these two hospitals developed the complication over the study period, with identifiable high-risk groups and an associated protective effect of preventive medication. Because the data come from medical records at two hospitals in one region of Ethiopia, the figures describe that specific multicenter population and time period rather than a national estimate, and the retrospective cohort design means the predictor estimates should be interpreted as associations from routine care data. The findings add to a growing body of Ethiopian research on venous thromboembolism, including earlier retrospective cohort studies at Hawassa University Comprehensive Specialized Hospital and tertiary hospitals in Addis Ababa, as well as a 2025 systematic review and meta-analysis of deep vein thrombosis in the country.

Subject of Research: The incidence and associated factors of postoperative deep vein thrombosis among orthopedic surgery patients in Northwest Ethiopia

Article Title: 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

Article References: Bayu, H. T., Kefale, W. M., Zeru, G. A., Molla, M. T., Kumie, F. T., Ayalew, S. B., Dejen, E. T., Demlie, A. E., & Endeshaw, A. S. (2026). 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. BMC Musculoskeletal Disorders. https://doi.org/10.1186/s12891-026-10674-7

Image Credits: AI Generated

DOI: 10.1186/s12891-026-10674-7

Keywords: deep vein thrombosis, orthopedic surgery, Ethiopia, retrospective cohort study, thromboprophylaxis, pelvic fracture, femoral fracture, pulmonary embolism, postoperative complications, low-resource setting, risk factors, multivariable logistic regression