Head and Neck Microsurgeon Practice Patterns and Perceptions Regarding Venous Thromboembolism ProphylaxisFunding None.
Background Patients undergoing head and neck (H&N) microvascular reconstruction comprise a population at high risk for venous thromboembolism (VTE). Free flap and VTE thromboprophylaxis may coincide but tend to vary from surgeon to surgeon. This study identifies VTE prophylaxis patterns and perceptions among H&N microsurgeons in the United States.
Methods An online survey on VTE prophylaxis practice patterns and perceptions was emailed to 172 H&N microsurgeons in the United States using an anonymous link.
Results There were 74 respondents (43% response rate). These surgeons completed residencies in otolaryngology (59%), plastic surgery (31%), and oral maxillofacial surgery (7%). Most underwent fellowship training (95%) and have practiced at an academic center (97%) for at least 6 years (58%), performing an average of 42 ± 31 H&N free flap cases per year (range = 1–190). Most adhered to general VTE prophylaxis guidelines (69%) while 11% did not and 20% were unsure. Nearly all surgeons (99%) would provide prophylactic anticoagulation, mostly in the form of subcutaneous heparin (51%) or enoxaparin (44%); 64% additionally used aspirin, while 4% used aspirin alone. The majority of surgeons (68%) reported having postoperative VTE complications, with six surgeons (8%) reporting patient deaths due to pulmonary embolism. A third of the surgeons have encountered VTE prophylaxis-related adverse bleeding events, but most still believe that chemoprophylaxis is important for VTE prevention (92%). While 35% of surgeons were satisfied with their current practice, most would find it helpful to have official prophylactic anticoagulation guidelines specific to H&N free flap cases.
Conclusion The majority of microsurgeons experienced postoperative VTE complications after H&N free flap reconstruction despite the routine use of prophylactic anticoagulation. Though bleeding events are a concern, most surgeons believe chemoprophylaxis is important for VTE prevention and would welcome official guidelines specific to this high-risk population.
Preliminary results were presented as a podium presentation at the 63th Annual Robert H. Ivy Pennsylvania Plastic Surgery Society Meeting, in Philadelphia, PA, April 2017, and as a poster at the 60th Annual Meeting of the Ohio Valley Society of Plastic Surgeons, in Pittsburgh, PA, June 2017. This manuscript presents our final data and analysis.
This study was approved by the University of Pittsburgh Institutional Review Board and was performed in accordance with the principles set forth in the Declaration of Helsinki.
* These authors acted as co-first authors.
Received: 08 February 2020
Accepted: 11 April 2020
14 May 2020 (online)
Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.
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