Thực hành và quan điểm của bác sĩ về dự phòng thuyên tắc huyết khối tĩnh mạch sau phẫu thuật chỉnh hình lớn tại Bệnh viện trung ương quân đội 108
Cơ quan, tổ chức của tác giả
DOI:
https://doi.org/10.59882/1859-364X/221Từ khóa:
Venous thromboembolism prevention, major orthopaedic surgery, guideline adherence, influencing factors, mixed methods studyTóm tắt
Patients undergoing major orthopedic surgery (MOS) are at the highest risk of developing postoperative venous thromboembolism (VTE) complications. Despite widespread recommendations for routine VTE prophylaxis, multiple publications have indicated that discrepancies between practice and guidelines persist. Therefore, it is crucial to identify the contributing factors to lay a solid foundation for future improvements. This study aimed to investigate the practices of VTE prophylaxis in MOS patients and the factors perceived to influence physicians’ practices. This study employed a mixed methods approach in which medical records of 118 MOS patients were initially reviewed to measure adherence rates to guidelines. Subsequently, in-depth interviews were conducted with 15 surgeons based on the Theoretical Domain Framework to gain insights into the influencing factors of this practice. The research findings revealed the following compliance rates with VTE guidelines: indications (90.7%), anticoagulant choice (69.8%), dosage (91.9%), initiation time (100%), minimum duration of prevention (74.4%), and optimal prophylaxis duration (25.6%). Through in-depth interviews, we identified seven relevant theoretical domains influencing thromboprophylaxis practices. Main facilitators were adequate understanding of VTE prevention, consistent implementation, presence of hospital guideline, recognition of prevention benefits, and effective leadership. Frequently cited barriers included inadequate consideration of renal function, concerns about bleeding risks, impracticality of injectable treatments, absence of outpatient monitoring system, drugs’ high cost, and patient financial constraints. In conclusion, the study pinpointed certain facets of VTE prevention that require enhancement in MOS patients. The identified factors that have an impact on this practice will be used as a foundation for designing suitable interventions to enhance it at the facility.
Keywords: Venous thromboembolism prevention, major orthopaedic surgery, guideline adherence, influencing factors, mixed methods study
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