Abstract
BackgroundVenous thromboembolism (VTE) is a major cause of perioperative morbidity and mortality. Historically, otolaryngology surgery has been seen as very low risk of VTE, given the relatively short procedures and healthy patient population. However, head and neck surgery patients have multiple additional risk factors for VTE compared to general otolaryngology patients, and only recently has research been directed at examining this population of patients regarding VTE risk.ReviewVTE has long been recognized as a major issue in other surgical specialties, with VTE rates of 15–60 % in some specialties in the absence of prophylaxis with either mechanical compression or anticoagulation. Multiple large-scale retrospective studies have shown that the incidence of VTE in otolaryngology patients is quite low, ranging between 0.1 and 1.6 %. However, these studies indicated that head and neck cancer patients may have an increased risk of VTE. Further retrospective studies focusing on head and neck cancer patients found a VTE rate of approximately 2 %, but one study also found a suspected VTE rate of 5.6 % based on clinical symptoms, indicating that retrospective studies may underreport the true incidence. A single prospective study found a 13 % risk of VTE after major head and neck surgery. Furthermore, risk stratification using the Caprini risk assessment model demonstrates that the highest risk patients may have a VTE risk of 18.3 %, although this may be lowered (but not eliminated) through the use of appropriate prophylactic anticoagulation.ConclusionVTE is likely a more significant concern in head and neck surgery patients than previously realized. Appropriate prophylaxis with mechanical compression and anticoagulation is essential; risk stratification may serve as a useful tool to identify head and neck cancer patients at highest risk for VTE.
Highlights
Venous thromboembolism (VTE) is a major cause of perioperative morbidity and mortality
Venous thromboembolism is a major source of perioperative morbidity and mortality that is largely preventable
It accounts for approximately 10 % of hospital deaths annually [3], and patients that survive are at risk for further complications. Both surgery and cancer are major risk factors for VTE, compliance with chemoprophylaxis guidelines has traditionally been low in head and neck surgery
Summary
Venous thromboembolism (VTE) is a major cause of perioperative morbidity and mortality. Multiple large-scale retrospective studies have shown that the incidence of VTE in otolaryngology patients is quite low, ranging between 0.1 and 1.6 % These studies indicated that head and neck cancer patients may have an increased risk of VTE. Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common problem in hospitalized patients and can cause significant morbidity and mortality. This condition is responsible for 5 to 10 % of all hospital deaths, and is estimated to affect as many as 600,000 patients a year in the United States [1]. The incidence of VTE varies depending on the type of cancer, with malignancies of the bone, ovary, brain and liver/pancreas associated with the highest incidences [5, 6]
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