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

Head Neck. 2017 Dec;39(12):2450-2458. doi: 10.1002/hed.24914. Epub 2017 Sep 30.

Abstract

Background: Venous 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.

Methods: A 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.

Results: Of 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.

Conclusion: Our 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.

Keywords: head and neck neoplasm; risk factors; thrombolytic therapy; thromboprophylaxis; venous thromboembolism.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / administration & dosage*
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / surgery*
  • Cohort Studies
  • Disease-Free Survival
  • Female
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Male
  • Middle Aged
  • Neck Dissection / adverse effects
  • Neck Dissection / methods
  • Plastic Surgery Procedures / adverse effects*
  • Plastic Surgery Procedures / methods
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control
  • Primary Prevention / methods
  • Prognosis
  • Pulmonary Embolism / etiology
  • Pulmonary Embolism / mortality
  • Pulmonary Embolism / prevention & control
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Surgical Flaps / blood supply
  • Surgical Flaps / transplantation*
  • Survival Rate
  • Treatment Outcome
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / mortality
  • Venous Thromboembolism / prevention & control*

Substances

  • Anticoagulants