Risk of Venous Thromboembolism Among Otolaryngology Patients vs General Surgery and Plastic Surgery Patients

Cramer, John D.; Dilger, Amanda E.; Schneider, Alex; Smith, Stephanie Shintani; Samant, Sandeep; Patel, Urjeet A.

doi:10.1001/jamaoto.2017.1768

Cited by 24 publications

(62 citation statements)

References 26 publications

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“…Controlling for demographic and other operative factors, compared with general surgery (the specialty that treated the greatest number of patients in the study population), the present study found several surgical specialties to be independently associated with lower risk of VTE, including orthopedic surgery and plastic surgery (OR=0.496, p<0.001 and OR=0.141, p=0.001, respectively). The result of plastic surgery was consistent with adult literature 37. However, the result with orthopedic surgery was not expected and had not previously been reported.…”

Section: Discussionsupporting

confidence: 89%

Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

Mets

McLynn

Grauer

2020

World Jnl Ped Surgery

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BackgroundAlthough less common in adults, venous thromboembolism (VTE) in children is a highly morbid, preventable adverse event. While VTE has been well studied among pediatric hospitalized and trauma patients, limited work has been done to examine postoperative VTE in children undergoing surgery.MethodsUsing data from National Surgical Quality Improvement Project Pediatric database (NSQIP-P) from 2012 to 2016, a retrospective cohort analysis was performed to determine the incidence of, and risk factors for, VTE in children undergoing surgery. Additionally, the relationships between VTE and other postoperative adverse outcomes were evaluated.ResultsOf 361 384 pediatric surgical patients, 378 (0.10%) were identified as experiencing postoperative VTE. After controlling for patient and surgical factors, we found that American Society of Anesthesiologists (ASA) class of II or greater, aged 16–18 years, non-elective surgery, general surgery (compared with several other surgical specialties), cardiothoracic surgery (compared with general surgery) and longer operative time were significantly associated with VTE in pediatric patients (p<0.001 for each comparison). Furthermore, a majority of adverse events were found to be associated with increased risk of subsequent VTE (p<0.001).ConclusionIn a large pediatric surgical population, an incidence of postoperative VTE of 0.10% was observed. Defined patient and surgical factors, and perioperative adverse events were found to be associated with such VTE events.

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Section: Discussionsupporting

confidence: 89%

Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

Mets

McLynn

Grauer

2020

World Jnl Ped Surgery

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“…In another study by Garritano et al that surveyed otolaryngologists, they reported a considerable variability among otolaryngologists in using intraoperative and postoperative thromboprophylaxis, they also reported 88.3% of otolaryngologists stated they would find thromboprophylaxis guidelines released by the American Academy of Otolaryngology ‐ Head and Neck Surgery to be helpful . A similar findings of heterogeneity in thromboprophylaxis utilization by otolaryngologists in UK were reported in a survey by Nash et al A recent study by Cramer et al evaluated the utility of American College of Chest Physicians guidelines (ACCP) using Caprini scores for risk stratification of patients undergoing otolaryngologic surgeries . They reported patients with a high risk of VTE based on Caprini score might benefit from chemoprophylaxis; however they also observed a higher risk of bleeding in patients with high Caprini score which they attributed to using anticoagulants.…”

Section: Discussionmentioning

confidence: 79%

“…This means pharynx and larynx were the only surgeries associated with a high risk of DVT and PE, as well as a high readmission risk. Cramer et al in their study that used data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) identified a subset of high‐risk procedures within otolaryngology that included free or regional tissue transfer, laryngectomy, composite resection, skull base surgery, and incision and drainage . Lee et al also reported that a higher risk of VTE was associated with major head and neck surgeries .…”

Section: Discussionmentioning

confidence: 99%

“…They reported patients with a high risk of VTE based on Caprini score might benefit from chemoprophylaxis; however they also observed a higher risk of bleeding in patients with high Caprini score which they attributed to using anticoagulants. They proposed a method to adapt the existing ACCP guidelines to otolaryngology and recommended further research to validate its utility …”

Section: Discussionmentioning

confidence: 99%

“…The perceived low incidence of VTE associated with head and neck surgeries and concerns regarding the side effects of bleeding and hematoma associated with anticoagulant medications have led to more judicious rather than routine use of chemoprophylaxis in otolaryngology. This is further compounded by lack of specific preventive guidelines in otolaryngology …”

Section: Introductionmentioning

confidence: 99%

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Venous thromboembolism in head and neck surgery: Risk, outcome, and burden at the national level

et al. 2018

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Background Venous thromboembolism (VTE) can complicate major surgeries. This study examines the risk and outcomes of VTE in patients who underwent head and neck surgeries. Methods Retrospective cross‐sectional analysis utilizing the Nationwide Readmissions Database (2010‐2014). Study population included adults (≥18 year) patients who underwent head and neck surgeries. Results A total 386 VTE patients and 116 450 controls included. VTE risk was 0.37%, postoperative mortality was 4.87%. Of VTE, 57.02% identified within the initial admission for surgery, while the rest required readmission within 90 days. VTE high‐risk surgeries included: major ear/skull base surgeries, major nose/paranasal sinuses surgeries, major mouth/tonsil surgeries, major salivary glands/ducts surgeries, major maxillofacial bones/mandible surgeries, and major and nonmajor pharynx and larynx surgeries (P < .05). Those same surgeries were also associated with a high risk of readmission (P < .05). Conclusions VTE is associated with a significant mortality risk. Surgeries that involve the pharynx and larynx have the highest risk of VTE and readmission.

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Association of Prolonged-Duration Chemoprophylaxis With Venous Thromboembolism in High-risk Patients With Head and Neck Cancer

Tipirneni

Bauter

Arnold

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Venous thromboembolism (VTE) is associated with substantial morbidity and is the most common factor associated with preventable death among hospitalized patients. Data from otolaryngologic studies suggest that the risk of VTE may be underestimated among high-risk patients, particularly among those undergoing oncologic procedures. The incorporation of prolonged-duration chemoprophylaxis (PDC) into preventive therapy has been associated with substantial decreases in VTE incidence among patients undergoing oncologic surgery. However, bleeding remains a major concern among otolaryngologists, and substantial variation exists in the use of thromboprophylaxis.OBJECTIVE To assess the association between PDC and VTE in high-risk patients with head and neck cancer undergoing oncologic procedures. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study identified 750 patients with biopsy-confirmed head and neck cancer and a Caprini risk score of 8 or higher who underwent inpatient oncologic surgery at a tertiary care referral center between January 1, 2014, and February 1, 2020. After exclusions, 247 patients were included in the study; patients were divided into 2 cohorts, traditional and PDC, based on the duration of prophylaxis. Univariate and multivariate analyses were performed to examine the development of VTE and bleeding-associated complications during the 30-day postoperative period. Data were analyzed from April 1 to April 30, 2020.EXPOSURES PDC, defined as 7 or more postoperative days of chemoprophylaxis.MAIN OUTCOMES AND MEASURES VTE and bleeding events during the 30-day postoperative period.RESULTS Among 247 patients (mean [SD] age, 63.1 [11.1] years; 180 men [72.9%]) included in the study, 106 patients (42.9%) received traditional prophylaxis, and 141 patients (57.1%) received PDC. The incidence of VTE was 5 of 106 patients (4.7%) in the traditional cohort and 1 of 141 patients (0.7%) in the PDC cohort (odds ratio [OR], 0.15; 95% CI, 0.003-1.33). In the multivariate logistic regression analysis, PDC was independently associated with reductions in the risk of VTE (OR, 0.04; 95% CI, 0.001-0.46). The incidence of bleeding events was 1 of 106 patients (0.9%) in the traditional cohort and 6 of 141 patients (4.3%) in the PDC cohort (OR, 4.64; 95% CI,. CONCLUSIONS AND RELEVANCEThe use of chemoprophylaxis for high-risk patients with head and neck cancer remains a high-priority topic. The results of this study suggest that PDC may be associated with reductions in VTE among this patient population. However, the associated increase in nonfatal bleeding events warrants careful consideration and further highlights the need to determine an optimal duration for chemoprophylaxis among this distinct cohort.

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Risk of Venous Thromboembolism Among Otolaryngology Patients vs General Surgery and Plastic Surgery Patients

Cited by 24 publications

References 26 publications

Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

Venous thromboembolism in children undergoing surgery: incidence, risk factors and related adverse events

Venous thromboembolism in head and neck surgery: Risk, outcome, and burden at the national level

Association of Prolonged-Duration Chemoprophylaxis With Venous Thromboembolism in High-risk Patients With Head and Neck Cancer

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