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Surgery for head and neck cancers increased VTE risk
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Patients who underwent surgery for head and neck cancers and did not receive anticoagulation therapy were at increased risk for venous thromboembolism, according to results of a prospective study.
Prior studies have shown the risk for venous thromboembolism (VTE) in general otolaryngology patients ranges from 0.1% to 2.4%. However, VTE risk is higher among patients with head and neck cancers due to several factors, including older age, tobacco use and decreased pulmonary function, according to background information provided by researchers.
The current analysis included 100 patients who underwent surgery for head and neck cancers. Median age was 63.5 years. Most of the patients were men (58%) and had a history of smoking (73%).
Eighty percent of the surgeries involved microvascular reconstruction.
Thirteen patients developed VTE within 30 days post surgery. Of them, eight were symptomatic superficial VTE, deep venous thrombosis or pulmonary embolism, and thus were classified as clinically significant. The other five patients developed asymptomatic lower extremity superficial VTE detected only by ultrasound.
Researchers identified no risk factors of statistical significance. However, they found patients who developed VTE were more likely to have lower Karnofsky performance status scores (72 vs. 79; P=.09) and higher Caprini risk assessment scores (7.6 vs. 6.9; P=.09).
Fourteen patients received postoperative anticoagulation treatment. Researchers reported a higher rate of bleeding complications among this group than the rest of the study population (30.1% vs. 5.6%; P=.01). One patient who received anticoagulation therapy developed VTE (7%).
“Our results support the use of routine VTE chemoprophylaxis in patients with head and neck cancer admitted for more than 72 hours after surgery,” the researchers concluded. “Importantly, these data establish a baseline VTE rate in high-risk head and neck cancer surgery patients that can serve as a benchmark for future prospective trials of VTE chemoprophylaxis and risk stratification.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Matthew Old, MD
Venous thomboembolism (VTE) in head and neck cancer surgical patients is a significant and likely underestimated problem. This prospective study helps demonstrate that its incidence is higher than previously reported but lower than in many other surgical oncology fields. Due to the implementation of the Patient Protection and Affordable Care Act, and the rising emphasis of higher-quality care, it is imperative to continue investigating complications and interventions in real time. The results contribute to achieving quality standards. A reduction of VTE events can be accomplished effectively with a variety of well-defined treatment protocols so long as caution is maintained and the study complication rates related to prophylactic therapy is continued. Ongoing analysis of this relationship allows providers to develop an appropriate risk–benefit ratio of prophylactic therapy for patients, as well as opportunities to modify and improve treatment.
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