Venous Thromboembolism Rates Following Free Flap Reconstruction of the Head and Neck Region in a Tertiary Care Hospital
Fuat Baris Bengur, MD; Rakan Saadoun, MD; Elizabeth A. Moroni, MD, MHA; Nayel Khan, MD; Shaum Sridharan, MD; Mark Kubik, MD; Mario G. Solari, MD
University of Pittsburgh, Department of Plastic Surgery
Background: Venous thromboembolism (VTE) continues to be a major concern for the postoperative hospitalized patient, especially after long and complex procedures. Cancer itself also contributes to the hypercoagulable state, further complicating the management of patients. Despite prophylaxis, breakthrough events occur. We aimed to assess our institutional VTE and bleeding rates following free flap reconstruction of the head and neck region and the factors associated with these events.
Methods: A retrospective review of the patients who underwent head and neck free flap reconstruction at a tertiary center from 2012 to 2021 was performed from a prospectively maintained database. Data regarding patient demographics, past medical history, surgical details, and overall outcomes were collected. Outcomes studied included postoperative 30-day VTE rates and bleeding events. VTE was defined as documented pulmonary embolism or deep venous thrombosis events. Bleeding events included major events that required an intervention or return to the OR. Patients that had a VTE event were compared with the rest of the cohort to identify factors associated with VTE. Statistical analysis was performed using chi-square and T-tests, and P-value ? 0.05 was considered statistically significant.
Results: Free flap reconstruction of the head and neck region was performed in 928 patients. Reconstruction after cancer extirpation was the most common etiology (89%). The most preferred donor site was thigh (50%), followed by fibula (29%). All patients received postoperative VTE chemoprophylaxis, and the most common regimen was enoxaparin 30 mg BID (83%). The VTE and bleeding rates over the 10-year period were 4% (n=35) and 9% (n=82), respectively. Pulmonary comorbidities were found to be significantly higher in patients that had a VTE event (57% vs 26%, p<0.001). The ischemia duration of the flaps in patients with a VTE event was longer (149±57 vs 126±44, p=0.005), despite having similar overall operative duration (712±153 vs 695±152, p=0.517). Patients with a VTE event also had higher rates of bleeding events (29% vs 8%, p<0.001) and had a prolonged hospital stay of 11 more days (22±19 vs 11±7, p=0.001).
Conclusion: Postoperative VTE is a significant complication, associated with increased length of hospitalization in patients undergoing free flap reconstruction of the head and neck region. There is also a relation of VTE with major bleeding events, likely due to the VTE treatment. Institutional measures should be implemented on an individualized basis based on patient comorbidities to improve the postoperative VTE rates, while balancing the bleeding events.
Back to 2022 Posters