Author(s)
Michael Edwards, MD
Amy L. Rutt, DO FACS
John Casler, MD
Aaron Spaulding, PhD
Diyya Muraleedharan, MBBS
Emily Brennan, MPH
Affiliation(s)
Mayo Clinic;
Abstract:
<u>Educational Objective:</u> At the conclusion of this presentation, the participants should be able to understand venous thromboembolism (VTE) in otolaryngology (ORL) cases is low but can cause significant morbidity and mortality for in-hospital and post-discharge. Participants should be able to determine the utilization of Caprini risk stratified VTE prophylaxis and impact on VTE and bleeding outcomes in patients after (ORL) surgeries. <br><u>Objectives:</u> This study aimed to determine the utilization of Caprini risk stratified VTE prophylaxis and impact on VTE and bleeding outcomes in patients after otorhinolaryngologic (ORL) surgeries in an academic hospital system. <br><u>Study Design:</u> This is a retrospective cohort study of elective inpatient otorhinolaryngologic surgeries performed between 2016 and 2021. Data was obtained from a large academic health system's electronic medical records. All inpatient ORL elective surgeries between these dates were identified. <br><u>Methods:</u> The primary dependent variable was risk stratified VTE prophylaxis utilization (appropriate prophylaxis). Patients' risk of experiencing postoperative was identified by retrospective calculation of Caprini score. As secondary measures, inpatient, 30, and 90 day deep vein thrombosis (DVT), pulmonary embolism (PE), and venous thromboembolism (VTE) events were determined using ICD-10 codes. Further, bleeding episodes before discharge and within 30 and 90 days of discharge were evaluated. Logistic regression models were used to determine predictors of receiving appropriate prophylaxis, and postoperative VTE or bleeding. R statistical software was utilized for statistical analyses and p value < 0.05 was considered significant. <br><u>Results:</u> Inpatient postoperative PE (0% vs.45%, p<0.005) and VTE (0.2% vs. 0.73%, p0.023) were lower in those receiving appropriate prophylaxis. All discharge VTE events occurred in those not receiving appropriate prophylaxis. Inpatient (2.8% vs. 1.7%), p0.015), but not discharge bleeding rates higher in those who received appropriate prophylaxis. <br><u>Conclusions:</u> While Caprini VTE risk stratified prophylaxis has a positive impact in reducing inpatient postoperative PE and VTE, it still poses a chance for postoperative bleeding. Mitigation strategies should be a priority in order to use appropriate prophylaxis without the risk of bleeding.