Cramer JD, et al. - This research aspired to contemplate the rate of venous thromboembolism (VTE) for several otolaryngology procedures in contrast with an established average-risk field (general surgery) and low-risk field (plastic surgery). A low risk of VTE was disclosed in maximum patients undergoing otolaryngology procedures. Hence, the guidelines for a low-risk population could be adapted to otolaryngology. Patients undergoing high-risk otolaryngology procedures were recommended to be taken into account as candidates for more aggressive VTE prophylaxis.

Methods

• A comparative study was pursued of the rate of VTE after different otolaryngology procedures with those of general and plastic surgery in the American College of Surgeons National Surgical Quality Improvement Program from January 1, 2005, through December 31, 2013.
• In order to compare different risk stratification of patients, univariate and multivariable logistic regression analysis of clinical characteristics, cancer status, and Caprini score were used.
• Data analysis was carried out from May 1, 2016, to April 1, 2017.
• Surgery was included as a part of the exposure.
• The main measure comprised of thirty-day rate of VTE.

Results

• A comparison was performed between 1295291 patients, including 31896 otolaryngology patients (mean [SD] age, 53.9 [16.7] years; 14 260 [44.7%] male; 21 603 [67.7%] white), 27280 plastic surgery patients (mean [SD] age, 50.5 [13.9] years; 4835 [17.7%] male; 17 983 [65.9%] white), and 1236115 general surgery patients (mean [SD] age, 54.9 [17.2] years; 484 985 [39.2%] male; 867 913 [70.2%] white).
• The overall 30-day rate of VTE was 0.5% for otolaryngology compared with 0.7% for plastic surgery and 1.2% for general surgery.
• A high-risk group was detected for VTE in otolaryngology (n=3625) that comprised of free or regional tissue transfer, laryngectomy, composite resection, skull base surgery, and incision and drainage.
• Similar rates of VTE were experienced by high-risk otolaryngology patients as the general surgery patients across all Caprini risk levels.
• Low-risk otolaryngology patients (n=28271) reported lower rates of VTE than plastic surgery patients across all Caprini risk levels.
• Malignant tumors displayed a correlation with VTE.
• Nonetheless, variation was unveiled in the rates by cancer type and were 11-fold greater for cancers of the upper aerodigestive tract compared with thyroid cancers (odds ratio, 10.97; 95% CI,7.38-16.31).
• A link was brought to light between venous thromboembolism with a 14-fold higher 30-day mortality among otolaryngology patients (5.1% mortality with VTE vs 0.4% mortality without VTE; difference, 4.7%; 95% CI of the difference, 2.2%-9.3%).