Current practices in venous thromboembolism prophylaxis in otolaryngology–head and neck surgery

Garritano, Frank G.; Andrews, Genevieve A.

doi:10.1002/hed.23998

Cited by 23 publications

(27 citation statements)

References 20 publications

(53 reference statements)

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“…Before reviewing any articles, a number of techniques were used to ensure that all the relevant references were included in our search algorithm and results. Citations were cross‐checked (snowballing) from key publications . Citations from existing reviews were assessed, the “related articles” to key publications in PubMed were reviewed, forward citations were used, and one expert in the field (S.P.…”

Section: Methodsmentioning

confidence: 99%

Systematic review and meta‐analysis of venous thromboembolism in otolaryngology–head and neck surgery

et al. 2017

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Section: Methodsmentioning

confidence: 99%

Systematic review and meta‐analysis of venous thromboembolism in otolaryngology–head and neck surgery

et al. 2017

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“…Garritano et al reported that 7 of 11 surgical services were more likely than the otolaryngology service to provide patients with the institutionally recommended VTE prophylaxis . 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 .…”

Section: Discussionmentioning

confidence: 92%

“…Chemoprophylaxis are routinely used in general, orthopedic, urologic surgeries due to high risk of VTE. In otolaryngology, the adoption of routine use of prophylactic anticoagulant medications is less pronounced mainly because of the low risk of VTE in general and the potentially more harmful side effect of chemoprophylaxis that can result in bleeding or hematoma of or around the aerodigestive tract . Garritano et al reported that 7 of 11 surgical services were more likely than the otolaryngology service to provide patients with the institutionally recommended VTE prophylaxis .…”

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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“…6,13,14 Currently, prophylaxis regimens for H&N free flap patients tend to be surgeon specific. 15,16 Recent studies indicate that standard VTE prophylaxis practices may be inadequate 15,17,18 and that chemoprophylaxis continues to be underutilized among microsurgeons in their free flap patients, 11,19,20 perhaps in part due to the lack of standardized evidence-based guidelines for VTE prophylaxis in H&N free flap surgeries. 11,[21][22][23][24] Free flap patients often receive anticoagulation to prevent flap thrombosis, which may overlap with VTE prophylaxis needs.…”

mentioning

confidence: 99%

Head and Neck Microsurgeon Practice Patterns and Perceptions Regarding Venous Thromboembolism Prophylaxis

Venkatesh

Ambani

Arakelians

et al. 2020

J Reconstr Microsurg

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Background Patients undergoing head and neck (H&N) microvascular reconstruction comprise a population at high risk for venous thromboembolism (VTE). Free flap and VTE thromboprophylaxis may coincide but tend to vary from surgeon to surgeon. This study identifies VTE prophylaxis patterns and perceptions among H&N microsurgeons in the United States. Methods An online survey on VTE prophylaxis practice patterns and perceptions was emailed to 172 H&N microsurgeons in the United States using an anonymous link. Results There were 74 respondents (43% response rate). These surgeons completed residencies in otolaryngology (59%), plastic surgery (31%), and oral maxillofacial surgery (7%). Most underwent fellowship training (95%) and have practiced at an academic center (97%) for at least 6 years (58%), performing an average of 42 ± 31 H&N free flap cases per year (range = 1–190). Most adhered to general VTE prophylaxis guidelines (69%) while 11% did not and 20% were unsure. Nearly all surgeons (99%) would provide prophylactic anticoagulation, mostly in the form of subcutaneous heparin (51%) or enoxaparin (44%); 64% additionally used aspirin, while 4% used aspirin alone. The majority of surgeons (68%) reported having postoperative VTE complications, with six surgeons (8%) reporting patient deaths due to pulmonary embolism. A third of the surgeons have encountered VTE prophylaxis-related adverse bleeding events, but most still believe that chemoprophylaxis is important for VTE prevention (92%). While 35% of surgeons were satisfied with their current practice, most would find it helpful to have official prophylactic anticoagulation guidelines specific to H&N free flap cases. Conclusion The majority of microsurgeons experienced postoperative VTE complications after H&N free flap reconstruction despite the routine use of prophylactic anticoagulation. Though bleeding events are a concern, most surgeons believe chemoprophylaxis is important for VTE prevention and would welcome official guidelines specific to this high-risk population.

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Current practices in venous thromboembolism prophylaxis in otolaryngology–head and neck surgery

Abstract: Current practices in venous thromboembolism prophylaxis vary widely among the otolaryngology community. A set of clear specialty-specific guidelines may be helpful. © 2015 Wiley Periodicals, Inc. Head Neck 38: E341-E345, 2016.

Cited by 23 publications

References 20 publications

Systematic review and meta‐analysis of venous thromboembolism in otolaryngology–head and neck surgery

Systematic review and meta‐analysis of venous thromboembolism in otolaryngology–head and neck surgery

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

Head and Neck Microsurgeon Practice Patterns and Perceptions Regarding Venous Thromboembolism Prophylaxis

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