Assessing Effectiveness and Compliance Barriers of Intermittent Pneumatic Compression Devices in Preventing Venous Thromboembolism After Femoral Fracture Surgery.

AIMS/BACKGROUND: Venous thromboembolism (VTE) is a frequent complication following femoral fracture surgery. While intermittent pneumatic compression (IPC) devices serve as an effective mechanical prophylaxis, patient compliance is often suboptimal. This study aimed to investigate the effectiveness of IPC in preventing VTE after femoral fracture surgery and to analyse the key factors influencing patient compliance.

METHODS: This retrospective study included 213 patients with femoral fractures who underwent surgical treatment at Ningbo No.6 Hospital between December 2021 and December 2024. Based on postoperative IPC device usage records from medical charts, patients were divided into a good compliance group (n = 51) and a compliance barrier group (n = 162). Postoperative coagulation parameters [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), and D-dimer (D-D)], VTE incidence at 5 days postoperatively, and the length of hospital stay were systematically collected and compared between the two groups. A self-designed questionnaire was used to assess factors influencing IPC compliance barriers.

RESULTS: Among the 213 included patients who underwent femoral fracture surgery, the incidence of postoperative IPC device compliance barriers was 76.06% (162/213). At 5 days postoperatively, significant differences were observed in all coagulation parameters between the two groups. Specifically, the good compliance group had significantly higher PT, APTT, and TT levels compared with the compliance barrier group (all p < 0.05). In contrast, FIB and D-D levels were significantly lower in the good compliance group (all p < 0.05). Regarding clinical outcomes, the incidence of VTE in the good compliance group was 19.61%, significantly lower than the 38.27% in the compliance barrier group (p = 0.014). Furthermore, the median length of hospital stay in the good compliance group [8.00 (8.00, 17.00) days] was significantly shorter than that in the compliance barrier group [12.00 (9.00, 17.00) days] (p = 0.009). The survey results of 162 patients in the compliance barrier group showed that the main obstacles affecting IPC device application compliance were concentrated at the level of patient cognition, experience, and perception. A smaller proportion of patients had concerns about out-of-pocket costs. Healthcare-related factors and device-related factors had a relatively lower impact.

CONCLUSION: The use of IPC after femoral fracture surgery can effectively improve the hypercoagulable state, reduce the incidence of VTE, and shorten hospitalization. However, patient compliance is generally low, primarily influenced by insufficient cognition, poor user experience, and low perceived value of treatment. It is recommended to improve compliance through systematic health education, optimizing comfort and convenience of use, strengthening healthcare follow-up and feedback, and ensuring device maintenance and configuration.