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Otolaryngol Head Neck Surg. 2019 Mar 12:194599819835743. doi: 10.1177/0194599819835743. [Epub ahead of print]

Postoperative Venous Thromboembolism after Extracranial Otologic Surgery.

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1
1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.

Abstract

OBJECTIVE:

To determine the incidence of postoperative venous thromboembolism (VTE) in adults undergoing otologic surgery.

STUDY DESIGN:

Cross-sectional retrospective study.

SETTING:

Single tertiary academic center.

SUBJECTS AND METHODS:

Adults undergoing nononcologic, extracranial otologic surgery from August 2009 to December 2016. Patients with postoperative diagnosis VTE codes were identified. Imaging and clinical documents were searched for VTE evidence within the first 30 postoperative days. Methods of thromboprophylaxis were documented, and Caprini risk scores were calculated.

RESULTS:

In total, 1213 otologic surgeries were evaluated. No postoperative VTE events were identified (0/1268). Mean age was 51.0 ± 17.3 years (range, 18.1-93.4 years). Average length of surgery was 136.0 ± 79.0 minutes (range, 5-768 minutes). The average Caprini score in all patients was 4.0 ± 1.7 (range, 1-15). Eighty-five percent of patients had a Caprini score ≥3, the threshold at which chemoprophylaxis has been recommended in general surgery patients by the American College of Chest Physicians 2012 guidelines. Six patients had documented preoperative chemoprophylaxis and a Caprini score of 4.8 ± 1.7. This was not significantly different from that of patients who did not receive preoperative chemoprophylaxis ( t test, P = .3). The literature would estimate a rate of 3.7% VTE in adults with similar Caprini scores undergoing general surgery procedures with no VTE prophylaxis.

CONCLUSION:

The Caprini risk assessment model may overestimate VTE risk in patients undergoing extracranial otologic surgery. Postoperative VTE following otologic surgery is rare, even in patients traditionally considered moderate or high risk. Chemoprophylaxis guidelines in this group should be balanced against the potential risk of increased intraoperative bleeding and its associated effects on surgical visualization and morbidity.

KEYWORDS:

Caprini score; deep venous thrombosis; otologic surgery; pulmonary embolism

PMID:
30857484
DOI:
10.1177/0194599819835743

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