Deep Venous Thrombosis and Pulmonary Embolism in Otolaryngology Surgery Patients: An Analysis Using NSQIP

Abstract

Objectives:

1) Compare rates of post-operative deep venous thrombosis (DVT) and pulmonary embolism (PE) in otolaryngology surgery (OTO-HNS) to other surgical fields. 2) Determine if otolaryngology and cancer are significantly associated with differing proportion of DVT and PE.

Methods:

Using the American College of Surgeons National Surgery Quality Improvement Program (NSQIP) database, 1,300,956 cases (2006-2010) were analyzed for DVT and PE complications. Otolaryngology DVT and PE complication rates were compared to other specialties using Pearson’s Chi-Square test. These data were analyzed using a logistic regression analysis (Logit binomial model) to determine the association of OTO-HNS and cancer with proportion of DVT or PE occurrence. Seventy-three variables from NSQIP were identified as controls for patient demographics, pre-operative, and intra-operative factors.

Results:

OTO-HNS has decreased prevalence of DVT (OR=0.37; p<0.001) and PE (OR=0.43; p=0.001) compared to other surgeries specialties. Odds ratios for DVT and PE in OTO-HNS patients with cancer were 4.35 (p<0.001) and 3.86 (p<0.001) respectively. However, OTO-HNS was associated with significantly increased proportion of DVT (p<0.001) and PE (p=0.008) while cancer was associated with decreased DVT and PE (both p<0.001).

Conclusions:

Otolaryngology patients experience post-operative DVT and PE less frequently than patients undergoing other types of surgery. However, when controlling for other potential risk factors, OTO-HNS has increased risk for DVT and PE. Given the nature of the specialty, otolaryngologists may not be as aggressive in preventing DVT and PE as their peers. This may prompt otolaryngologists to revisit their standards of practice.