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Preperitoneal Pelvic Packing is Associated With Increased Risk of Venous Thromboembolism

Jonathan J Parks1, Leon Naar1, Mary Bokenkamp1

  • 1Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.

The Journal of Surgical Research
|August 14, 2022
PubMed

Insights

Preperitoneal pelvic packing (PPP) for severe pelvic fractures increases the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Vigilant screening for these conditions is crucial in patients undergoing PPP.

Area of Science:

  • Trauma Surgery
  • Vascular Surgery
  • Critical Care Medicine

Background:

  • Preperitoneal pelvic packing (PPP) is a critical intervention for managing severe pelvic hemorrhage in blunt trauma.
  • The potential association between PPP and venous thromboembolism (VTE) requires further investigation.

Purpose of the Study:

  • To investigate the hypothesis that PPP is associated with an increased incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Main Methods:

  • Retrospective cohort analysis of blunt trauma patients with severe pelvic fractures (AIS ≥4) from 2015-2017.
  • Propensity score matching was used to compare patients who underwent PPP within 4 hours of admission with those who did not.
  • Comparison of DVT and PE rates between matched groups.

Main Results:

  • Out of 5129 patients, 157 underwent PPP and were matched with 157 controls.
  • No significant differences in baseline variables, mortality, or end-organ failure were observed between groups.
  • PPP patients had significantly higher rates of DVT (12.7% vs 5.1%) and PE (5.7% vs 0.0%).

Conclusions:

  • Preperitoneal pelvic packing for severe pelvic fractures in blunt trauma is linked to a higher risk of DVT and PE.
  • Maintain a high index of suspicion and low threshold for screening for DVT and PE in patients who have undergone PPP.
Abstract

Keywords:
Deep vein thrombosisPreperitoneal pelvic packingPulmonary embolism

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