Venous thromboembolism in patients with head and neck cancer after surgery

Background. The purpose of this study was to report the incidence of venous thromboembolism (VTE) in patients with head and neck cancer after surgery. Methods. This was a single-institution, retrospective cohort: 134 patients underwent resection and simultaneous microvascular reconstruction. The primary endpoint was identification of confirmed or suspicious VTE within 30 days of surgery. Results. Two subjects (1.4%) with confirmed VTE (1 pulmonary embolism, 1 deep venous thrombosis) and 6 subjects (4.4%) with suspicious VTE (1 acute respiratory failure, 1 sudden cardiac arrest, and 4 cases of leg edema without imaging) were identified. The strongest predictors of possible VTE were prior VTE (p ¼ .004; odds ratio (OR), 25.11; 95% confidence interval (CI), 1.13-556.40), red cell transfusion (p ¼ .009; OR, 1.80; 95% CI, 1.16-2.80), high body mass index (p ¼ .015, OR, 1.29, 95% CI, 1.05-1.58), and older age (p ¼ .046; OR, 1.10; 95% CI, 1.00-1.19). Conclusion. The incidence of VTE in patients with head and neck cancer after resection and microvascular reconstruction ranged from 1.4% to 5.8%. V C 2012 Wiley Periodicals, Inc. Head Neck 35: 4-9, 2013 Venous thromboembolism (VTE) is a potentially life- threatening condition that includes both deep venous thrombosis (DVT) and pulmonary embolism (PE). Patients with cancer are at increased risk of developing a VTE. Cancer increases the risk of VTE by 4- to 6-fold. 1,2 A prothrombic state is also augmented in the surgical set- ting. Therefore, patients with cancer undergoing major surgery are considered particularly high risk for VTE. Patients with cancer undergoing surgery have a 2-fold risk of developing postoperative VTE compared with patients without cancer undergoing similar procedures. 1,3 The morbidity associated with VTE is substantial, ranging from chronic leg swelling to pulmonary embolism. In some cases, VTE can be fatal. In fact, VTE was recently reported to be the most common cause of death in the postoperative period among patients with cancer. 4 In accord with current criteria, most patients with head and neck cancer who have surgery are presumed to be high risk for developing VTE. 3,5 This is especially true for patients undergoing simultaneous microvascular free tissue transfer reconstruction after resection. The majority of patients with head and neck cancer presenting for oncologic resection and free tissue transfer reconstruction have commonly identified risk factors for VTE, notably advanced cancer stage, older age, and prolonged surgery time. Surprisingly, there have been few data to quantify the risk of VTE among patients with head and neck cancer undergoing surgery. The primary purpose of our study was to report the incidence of VTE in patients with head and neck cancer after resection and microvascular recon- struction. In addition, we aimed to identify potential risk factors for developing VTE for patients with head and neck cancer and to explore the impact of VTE on survival.