Risk of venous thromboembolism among otolaryngology patients vs general surgery and plastic surgery patients

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

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Importance: Venous thromboembolism (VTE), which includes deep venous thrombosis or pulmonary embolism, is the number 1 cause of preventable death in surgical patients. Current guidelines from the American College of Chest Physicians provide VTE prevention recommendations that are specific to individual surgical subspecialties; however, no guidelines exist for otolaryngology. Objective: To examine the rate of VTE for various otolaryngology procedures compared with an established average-risk field (general surgery) and low-risk field (plastic surgery). Design, Setting, and Participants: This cohort study compared 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.We used univariate and multivariable logistic regression analysis of clinical characteristics, cancer status, and Caprini score to compare different risk stratification of patients. Data analysis was performed from May 1, 2016, to April 1, 2017. EXPOSURE Surgery. Main Outcomes and Measures: Thirty-day rate of VTE. Results: A total of 1 295 291 patients, including 31 896 otolaryngology patients (mean [SD] age, 53.9 [16.7] years; 14 260 [44.7%] male; 21 603 [67.7%] white), 27 280 plastic surgery patients (mean [SD] age, 50.5 [13.9] years; 4835 [17.7%] male; 17 983 [65.9%] white), and 1 236 115 general surgery patients (mean [SD] age, 54.9 [17.2] years; 484 985 [39.2%] male; 867 913 [70.2%] white) were compared. 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.We identified a high-risk group for VTE in otolaryngology (n = 3625) that included free or regional tissue transfer, laryngectomy, composite resection, skull base surgery, and incision and drainage. High-risk otolaryngology patients experienced similar rates of VTE as general surgery patients across all Caprini risk levels. Low-risk otolaryngology patients (n = 28 271) experienced lower rates of VTE than plastic surgery patients across all Caprini risk levels. Malignant tumors were associated with VTE; however, the rates varied 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). Venous thromboembolism was associated 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%). Conclusions and Relevance: Most patients undergoing otolaryngology procedures are at low risk of VTE, indicating that guidelines for a low-risk population could be adapted to otolaryngology. Patients undergoing high-risk otolaryngology procedures should be considered as candidates for more aggressive VTE prophylaxis.

Original languageEnglish (US)
Pages (from-to)9-17
Number of pages9
JournalJAMA Otolaryngology - Head and Neck Surgery
Volume144
Issue number1
DOIs
StatePublished - Jan 1 2018

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Venous Thromboembolism
Otolaryngology
Plastic Surgery
Guidelines
Mortality
Neoplasms
Laryngectomy
Skull Base
Quality Improvement
Pulmonary Embolism
Thyroid Neoplasms
Venous Thrombosis
Drainage
Cause of Death

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

@article{258d61370f514143b5acb3057eb75346,
title = "Risk of venous thromboembolism among otolaryngology patients vs general surgery and plastic surgery patients",
abstract = "Importance: Venous thromboembolism (VTE), which includes deep venous thrombosis or pulmonary embolism, is the number 1 cause of preventable death in surgical patients. Current guidelines from the American College of Chest Physicians provide VTE prevention recommendations that are specific to individual surgical subspecialties; however, no guidelines exist for otolaryngology. Objective: To examine the rate of VTE for various otolaryngology procedures compared with an established average-risk field (general surgery) and low-risk field (plastic surgery). Design, Setting, and Participants: This cohort study compared 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.We used univariate and multivariable logistic regression analysis of clinical characteristics, cancer status, and Caprini score to compare different risk stratification of patients. Data analysis was performed from May 1, 2016, to April 1, 2017. EXPOSURE Surgery. Main Outcomes and Measures: Thirty-day rate of VTE. Results: A total of 1 295 291 patients, including 31 896 otolaryngology patients (mean [SD] age, 53.9 [16.7] years; 14 260 [44.7{\%}] male; 21 603 [67.7{\%}] white), 27 280 plastic surgery patients (mean [SD] age, 50.5 [13.9] years; 4835 [17.7{\%}] male; 17 983 [65.9{\%}] white), and 1 236 115 general surgery patients (mean [SD] age, 54.9 [17.2] years; 484 985 [39.2{\%}] male; 867 913 [70.2{\%}] white) were compared. 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.We identified a high-risk group for VTE in otolaryngology (n = 3625) that included free or regional tissue transfer, laryngectomy, composite resection, skull base surgery, and incision and drainage. High-risk otolaryngology patients experienced similar rates of VTE as general surgery patients across all Caprini risk levels. Low-risk otolaryngology patients (n = 28 271) experienced lower rates of VTE than plastic surgery patients across all Caprini risk levels. Malignant tumors were associated with VTE; however, the rates varied 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). Venous thromboembolism was associated 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{\%}). Conclusions and Relevance: Most patients undergoing otolaryngology procedures are at low risk of VTE, indicating that guidelines for a low-risk population could be adapted to otolaryngology. Patients undergoing high-risk otolaryngology procedures should be considered as candidates for more aggressive VTE prophylaxis.",
author = "Cramer, {John D.} and Dilger, {Amanda E.} and Alex Schneider and Smith, {Stephanie Shintani} and Sandeep Samant and Patel, {Urjeet A}",
year = "2018",
month = "1",
day = "1",
doi = "10.1001/jamaoto.2017.1768",
language = "English (US)",
volume = "144",
pages = "9--17",
journal = "JAMA Otolaryngology - Head and Neck Surgery",
issn = "2168-6181",
publisher = "American Medical Association",
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}

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.

In: JAMA Otolaryngology - Head and Neck Surgery, Vol. 144, No. 1, 01.01.2018, p. 9-17.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk of venous thromboembolism among otolaryngology patients vs general surgery and plastic surgery patients

AU - Cramer, John D.

AU - Dilger, Amanda E.

AU - Schneider, Alex

AU - Smith, Stephanie Shintani

AU - Samant, Sandeep

AU - Patel, Urjeet A

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Importance: Venous thromboembolism (VTE), which includes deep venous thrombosis or pulmonary embolism, is the number 1 cause of preventable death in surgical patients. Current guidelines from the American College of Chest Physicians provide VTE prevention recommendations that are specific to individual surgical subspecialties; however, no guidelines exist for otolaryngology. Objective: To examine the rate of VTE for various otolaryngology procedures compared with an established average-risk field (general surgery) and low-risk field (plastic surgery). Design, Setting, and Participants: This cohort study compared 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.We used univariate and multivariable logistic regression analysis of clinical characteristics, cancer status, and Caprini score to compare different risk stratification of patients. Data analysis was performed from May 1, 2016, to April 1, 2017. EXPOSURE Surgery. Main Outcomes and Measures: Thirty-day rate of VTE. Results: A total of 1 295 291 patients, including 31 896 otolaryngology patients (mean [SD] age, 53.9 [16.7] years; 14 260 [44.7%] male; 21 603 [67.7%] white), 27 280 plastic surgery patients (mean [SD] age, 50.5 [13.9] years; 4835 [17.7%] male; 17 983 [65.9%] white), and 1 236 115 general surgery patients (mean [SD] age, 54.9 [17.2] years; 484 985 [39.2%] male; 867 913 [70.2%] white) were compared. 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.We identified a high-risk group for VTE in otolaryngology (n = 3625) that included free or regional tissue transfer, laryngectomy, composite resection, skull base surgery, and incision and drainage. High-risk otolaryngology patients experienced similar rates of VTE as general surgery patients across all Caprini risk levels. Low-risk otolaryngology patients (n = 28 271) experienced lower rates of VTE than plastic surgery patients across all Caprini risk levels. Malignant tumors were associated with VTE; however, the rates varied 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). Venous thromboembolism was associated 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%). Conclusions and Relevance: Most patients undergoing otolaryngology procedures are at low risk of VTE, indicating that guidelines for a low-risk population could be adapted to otolaryngology. Patients undergoing high-risk otolaryngology procedures should be considered as candidates for more aggressive VTE prophylaxis.

AB - Importance: Venous thromboembolism (VTE), which includes deep venous thrombosis or pulmonary embolism, is the number 1 cause of preventable death in surgical patients. Current guidelines from the American College of Chest Physicians provide VTE prevention recommendations that are specific to individual surgical subspecialties; however, no guidelines exist for otolaryngology. Objective: To examine the rate of VTE for various otolaryngology procedures compared with an established average-risk field (general surgery) and low-risk field (plastic surgery). Design, Setting, and Participants: This cohort study compared 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.We used univariate and multivariable logistic regression analysis of clinical characteristics, cancer status, and Caprini score to compare different risk stratification of patients. Data analysis was performed from May 1, 2016, to April 1, 2017. EXPOSURE Surgery. Main Outcomes and Measures: Thirty-day rate of VTE. Results: A total of 1 295 291 patients, including 31 896 otolaryngology patients (mean [SD] age, 53.9 [16.7] years; 14 260 [44.7%] male; 21 603 [67.7%] white), 27 280 plastic surgery patients (mean [SD] age, 50.5 [13.9] years; 4835 [17.7%] male; 17 983 [65.9%] white), and 1 236 115 general surgery patients (mean [SD] age, 54.9 [17.2] years; 484 985 [39.2%] male; 867 913 [70.2%] white) were compared. 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.We identified a high-risk group for VTE in otolaryngology (n = 3625) that included free or regional tissue transfer, laryngectomy, composite resection, skull base surgery, and incision and drainage. High-risk otolaryngology patients experienced similar rates of VTE as general surgery patients across all Caprini risk levels. Low-risk otolaryngology patients (n = 28 271) experienced lower rates of VTE than plastic surgery patients across all Caprini risk levels. Malignant tumors were associated with VTE; however, the rates varied 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). Venous thromboembolism was associated 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%). Conclusions and Relevance: Most patients undergoing otolaryngology procedures are at low risk of VTE, indicating that guidelines for a low-risk population could be adapted to otolaryngology. Patients undergoing high-risk otolaryngology procedures should be considered as candidates for more aggressive VTE prophylaxis.

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