Justification of routine venous thromboembolism prophylaxis in head and neck cancer reconstructive surgery

• DOI: 10.1002/hed.24914
• Publication Date: 2017-09-30T10:46:58Z
• Authors: Hui Shan Ong; Sandhya Gokavarapu; Laith Al‐Qamachi; Min Yi Yin; Li Xin Su; Tong Ji; Chen Ping Zhang
• Keywords: Adult; Male; Anticoagulants; Middle Aged; Plastic Surgery Procedures; Prognosis; Risk Assessment; Disease-Free Survival; 3. Good health; Cohort Studies; Primary Prevention; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; ROC Curve; Head and Neck Neoplasms; Carcinoma, Squamous Cell; Humans; Neck Dissection; Female; Pulmonary Embolism; Aged; Retrospective Studies

AbstractBackgroundVenous thromboembolism (VTE) is a preventable complication in which early ambulation is expected after head and neck surgery. Thus, the role of VTE prophylaxis is questionable and needs further assessment. The purpose of this study was to specify the relative contributing risk factors for patients who underwent head and neck cancer ablation with immediate reconstruction.MethodsA retrospective analysis was conducted of consecutive head and neck cancer ablations with immediate reconstructions between 2008 and 2013. Dextran and prostaglandin E2 (PGE2) were routinely given as flap thromboprophylaxis. Logistic regression was applied to analyze the potentially significant risk factors.ResultsOf 1953 subjects, the incidence of symptomatic VTE was 2.2% with 0.1% mortality rate. Prolonged surgery (>592.5 minutes; P = .048), immobilization (>4 days; P = .019), and subjects without postoperative flap thromboprophylaxis (P = .002) are significant risk factors for VTE development.ConclusionOur flap thromboprophylaxis regime might have played a crucial role in keeping the incidence of VTE low. Despite prolonged immobilization in fibula flap reconstruction, the incidence of VTE remained low when flap thromboprophylaxis was given.