Is DVT prophylaxis necessary for thyroidectomy and parathyroidectomy?

Abstract

Recent guidelines suggest pharmacologic deep vein thrombosis (DVT) prophylaxis in all patients undergoing major surgical procedures to minimize the risk of postoperative DVT and pulmonary embolism (PE). Pharmacologic DVT prophylaxis perioperatively might increase the risk of bleeding complications. Our goal was to study the risk/benefit ratio of DVT prophylaxis in patients who undergo thyroidectomy and parathyroidectomy. A review of the ACS NSQIP Database from 2005 to 2007 was performed. The incidence of DVT/PE complications in a cohort of 347,862 patients was compared with the 16,022 patients who underwent a thyroidectomy or parathyroidectomy. We identified risk factors for DVT/PE and developed a surrogate variable to determine the risk for postoperative bleeding. The risk of DVT/PE complication in the thyroidectomy and parathyroidectomy patients (0.16) was 6 fold less than the entire cohort (0.96) (P < .001). The estimated risk of bleeding requiring a return to the operating room was 1.58%, which is 10-fold greater than the risk of developing a DVT/PE (P < .001). Patients who underwent thyroidectomy and parathyroidectomy have a low incidence of developing DVT/PE complications and have a significantly greater risk of developing bleeding complications. Hence, we believe that DVT prophylaxis should be done at the discretion of the surgeon in select high-risk patients only.