Implementation of a Novel Protocol for Preventing Venous Thromboembolism in Otolaryngology Patients.

Abstract

OBJECTIVE\nVenous thromboembolism (VTE) is a preventable cause of postoperative morbidity and mortality. The Caprini risk assessment model (CRAM) is a validated tool for estimating the risk for postoperative VTE. Previous studies demonstrated a low risk of VTE among otorhinolaryngology-head and neck surgery (ORL-HNS). Hence, our objective was to modify the CRAM-based protocol to be applicable for otolaryngology patients and assess protocol efficacy and safety.\n\n\nSTUDY DESIGN\nObservational pilot study conducted on ORL-HNS patients undergoing surgery.\n\n\nSETTING\nUniversity-affiliated tertiary care center.\n\n\nMETHODS\nWe constructed a modified protocol based on the CRAM and previous reports in the ORL-HNS literature using a reduced postoperative anticoagulation regimen. Primary end point was symptomatic VTE up to 3 months after surgery. Main secondary outcome was postoperative bleeding.\n\n\nRESULTS\nA total of 508 patients were enrolled. Of them, 48% underwent head and neck surgery, 18% direct laryngoscopy and transoral robotic surgery, 15% endoscopic sinus surgery, and 11% otology surgery. Adherence to the protocol was 79%. Mean follow-up time was 115 days (range, 30-448 days). Only 1 patient developed deep vein thrombosis, and none developed pulmonary embolism. Two patients had major bleeding not related to the use of anticoagulation.\n\n\nCONCLUSIONS\nOur novel CRAM-based protocol appears to be efficacious and safe for VTE prevention in otolaryngology. A larger-scale study is required to validate these findings.\n\n\nLEVEL OF EVIDENCE\nLevel 2b.