VTE after ENT surgery is rare overall, but 6% after free flaps

Design

Retrospective national database cohort

Population

277,187 adults having otolaryngology–head and neck surgery, 2015–2025

Primary outcome

Venous thromboembolism within 90 days

Effect

Overall 0.63%; free tissue transfer 6.1%; lateral skull base 4.4%

This retrospective study used a US aggregated database of 66 million patients to identify 277,187 adults who had otolaryngology–head and neck operations between 2015 and 2025, and recorded venous thromboembolism within 90 days.

The overall rate was 0.63%. By subspecialty it was highest in head and neck surgery (1.3%) and laryngology (1.0%), and lowest in sleep surgery (0.3%). Some procedure groups stood well apart: free tissue transfer (6.1%), lateral skull base surgery (4.4%), cricopharyngeal myotomy (3.1%) and anterior skull base surgery (3.1%). A previous VTE was by far the strongest risk factor (OR 12.3).

The point for practice is that a single ENT-wide prophylaxis policy fits poorly. Most ENT patients are at very low risk and chemoprophylaxis adds bleeding risk in vascular operative fields, but a small set of long, major procedures carries risk comparable to major general surgery. Risk factors were assessed only by univariable analysis, so the study identifies where to look rather than giving a prediction tool.

• Assess VTE risk procedure by procedure, rather than applying one policy across ENT.
• Consider chemoprophylaxis for free flap reconstruction and skull base surgery, where rates were 3–6%.
• Ask every patient about previous VTE; it carried about twelve times the odds.
• Use mechanical prophylaxis and early mobilisation as standard for longer operations.
• Weigh bleeding risk in the operative field when deciding on anticoagulant prophylaxis.

Why it matters

It shows where a low overall rate hides a high-risk minority.

Don't overread it

Risk factors were analysed one at a time from coded data; this is not a validated risk score.

The statistics, in plain English

A rate of 6.1% means about 6 in 100 free flap patients had a VTE within 90 days, compared with fewer than 1 in 100 overall. The odds ratio of 12.3 for prior VTE is unadjusted, so part of it may reflect other factors those patients share.

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