- Design
- Retrospective national database cohort
- Population
- 277,187 adults having ENT operations in the US, 2015-2025
- Primary outcome
- Venous thromboembolism within 90 days
- Effect
- 0.63% overall; free tissue transfer 6.1%; prior VTE OR 12.3
This retrospective study used a US aggregated database of 66 million patients to identify 277,187 adults having ENT operations between 2015 and 2025, and recorded venous thromboembolism within 90 days.
The overall rate was 0.63%. It was highest in head and neck surgery (1.3%) and laryngology (1.0%), and lowest in sleep surgery (0.3%). Within subspecialties, free tissue transfer (6.1%), lateral skull base surgery (4.4%), cricopharyngeal myotomy (3.1%) and anterior skull base surgery (3.1%) stood out. A previous clot was the strongest risk factor (OR 12.3), though only univariable analysis was reported.
The finding supports risk-stratified rather than blanket chemoprophylaxis: most ENT procedures carry little clot risk, while free-flap and skull base patients warrant formal assessment. A history of thrombosis should always prompt a plan.
- Assess clot risk formally before free-flap and skull base operations.
- Ask every patient about previous venous thromboembolism; it raised the odds about twelvefold.
- Avoid routine chemoprophylaxis for low-risk ENT procedures where bleeding risk outweighs clot risk.
- Use mechanical prophylaxis and early mobilisation for all major cases.
Why it matters
Blanket rules either overtreat minor cases or miss the few procedures with real risk.
Don't overread it
Risk factors were assessed only by univariable analysis, so they may overlap with each other.
The statistics, in plain English
Procedure-level rates come from coded data and may miss clots treated elsewhere. The odds ratio for prior clot is very large, but without adjustment it may partly reflect older age or cancer.
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