- Design
- Retrospective national database cohort, 2015–2025
- Population
- 277,187 adults after ENT surgery
- Primary outcome
- 90-day venous thromboembolism
- Effect
- Overall 0.63%; free flap 6.1%, lateral skull base 4.4%; prior VTE OR 12.3 (11.2–13.4)
This US database study, published in Otolaryngology–Head and Neck Surgery on 21 September, followed 277,187 adults for 90 days after ENT operations between 2015 and 2025. Venous thromboembolism occurred in 0.63%.
Rates varied widely. Head and neck surgery had the highest subspecialty rate (1.3%), followed by laryngology (1.0%), with sleep surgery lowest (0.3%). By procedure, free tissue transfer carried 6.1%, lateral skull base surgery 4.4%, and cricopharyngeal myotomy and anterior skull base surgery 3.1% each. A previous VTE was by far the strongest risk factor (OR 12.3).
A single ENT-wide approach to thromboprophylaxis fits these numbers poorly. Most patients are at very low risk, but free flap and skull base patients sit at rates where prophylaxis decisions deserve the same care as in major general surgery. The analysis was unadjusted and based on coding, so it describes risk rather than testing prophylaxis.
- Ask every ENT surgical patient about previous VTE; it raised the odds about twelvefold.
- Consider formal VTE risk assessment and chemoprophylaxis after free flap and skull base surgery.
- Most ENT procedures carried very low VTE risk; avoid routine prophylaxis where bleeding risk dominates.
- Continue mechanical prophylaxis and early mobilisation after long operations.
Why it matters
ENT surgery is often treated as low VTE risk, but some of its operations are not.
Don't overread it
Risk factors were assessed without adjustment; the study did not test prophylaxis.
The statistics, in plain English
A rate of 6.1% after free flaps means about 6 in 100 patients had a clot within 90 days. The odds ratio of 12.3 for prior VTE is unadjusted, so part of it may reflect other shared risk factors.
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