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Surgeon Practice Patterns and Perceptions Regarding Prophylaxis for Venous Thromboembolism in Head and Neck Free Flap Patients
Arakelians ARL, Ambani SW, Venkatesh KP, Johnson JT, Solari MS
University of Pittsburgh Department of Plastic Surgery
2017-02-12
Presenter: Aris Arakelians
Affidavit:
100% of this project is original work performed by medical student Aris Arakelians and fellow Shoshana Ambani.
Director Name: Michael Gimbel
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Patients undergoing head and neck (H&N) microvascular reconstruction are at high risk for venous thromboembolism (VTE). Free flap anticoagulation protocols can impact the decision to use VTE prophylaxis. This study sought to identify VTE prophylaxis patterns and perceptions among H&N microsurgeons.
Method: Potential H&N microsurgeons were identified using fellowship program listings. A survey eliciting VTE prophylaxis practices and perceptions was distributed via an anonymous email link.
Results: Of 172 potential H&N microsurgeons, 67 responded (39%). 61% percent of surgeons trained in Otolaryngology while 31% trained in Plastic Surgery. Most reported using established VTE prophylaxis guidelines (70%), while 10% do not. All surgeons use some form of VTE chemoprophylaxis, either subcutaneous (SQ) heparin (51%) or SQ enoxaparin (48%). Most surgeons reported having had patients with postoperative deep venous thrombosis (63%) and pulmonary embolism (54%). Five surgeons reported patient deaths due to PE (8%). 34% of surgeons have experienced adverse bleeding events related to VTE chemoprophylaxis. 91% of surgeons believe chemoprophylaxis to be important for VTE prevention in free flap patients. While 32% of surgeons are satisfied with their current practices, 49% would find it helpful to have official guidelines for both VTE prophylaxis and free flap anticoagulation in their microvascular patients.
Conclusions: The majority of H&N microsurgeons have experienced postoperative VTE complications after free flap reconstruction. Five surgeons reported patient deaths from PE. Most surgeons believe that chemoprophylaxis is important for VTE prevention and that guidelines specific to the free flap population would be useful.
